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HIALTH 


DEPARTMENT  OF  THE   INTERIOR 

BUREAU  OF  EDUCATION  :  ALASKA  SCHOOL  SERVICE 


MEDICAL  HANDBOOK 


EMIL  KRULISH,  M.  D. 

V.  a.  PUBLIC  HEALTH  SERVICE 
AND 

DANIEL  S.  NEUMAN,  M.  D. 

U.  S.  BUEEAU  OF  EDUCATION 


WASHINGTON 

GOVERNMENT   PRINTING  OFFICE 

1913 


^6 

'13 


%J     At,, 


This  publication  is  distributed  by  the  Bureau  of 
Education  only  to  its  employees  in  Alaska.  Persons 
desiring  copies  for  private  use  may  obtain  them  from 
the  superintendent  of  documents,  Government  Printing 
OflSice,  for  50  cents. 
2 


CONTENTS. 

Page. 

Preface 7 

Chapter  I.  Preparations,  weights,  and  measures.  9 

Chapter  II.  Drugs — physiological  actions,  doses  12 

Chapter  III.  Therapeutic  uses  of  drugs 15 

Chapter  IV.  The  administration  of  drugs 33 

Chapter  V.  Food  for  the  sick 36 

Chapter  VI.  Infant  feeding 38 

Chapter  VII.  Hints  on  doctoring 42 

Chapter  VIII.  Poultices  and  hot  fomentations .  _  45 

Chapter  IX.  Symptons 47 

Chapter  X.  Eruptive  fevers 58 

Chapter  XI.  Practice  of  medicine: 

Abortion 60 

Abscess 61 

Adenoids 61 

Anemia 62 

Appendicitis 62 

Asthma 63 

Backache 64 

Bed  sores 64 

Blood  poisoning 65 

Bronchitis 66 

Boils 66 

Bums  and  scalds 67 

Catarrh  of  the  bladder 68 

Chicken  pox 69 

Chilblains  and  frostbites 70 

Cholera  infantum 71 

3 


4  MEDICAL   HANDBOOK. 

Chapter  XI.  Practice  of  medicine — Continued.  Page. 

Colic,  infantile 72 

Constipation  and  carthartics 73 

Convulsions,  infantile 74 

Croup,  spasmodic 74 

Coryza 75 

Diarrhea 76 

Diphtheria 77 

Dyspepsia 78 

Dog  or  other  animal  bites_ ._ 79 

Diseases  of  the  eye 80 

Earache 91 

Eczema 92 

Epistaxis  (nosebleed) 94 

Erysipelas 95 

Gangrene 9Q 

Gonorrhea 97 

Indigestion 98 

Headache 98 

Heart  disease 100 

Heart  palpitation 101 

Hemoptysis  (bleeding  from  the  lungs) 102 

Hemorrhoids  (piles) 103 

Herpes 103 

Herpes  zoster  (shingles) 103 

Hives 104 

Infantile  paralysis 105 

Influenza  (la  grippe) 106 

Jaundice 107 

Kidney  congestion 107 

Lice 108 

Measles 108 

Meningitis 110 

Mumps 110 


CONTENTS.  5 

Chapter  XI.  Practice  of  medicine — Continued.  pa^e. 

Neuralgia 111 

Neurasthenia 111 

Orchitis  (inflammation  of  the  testicles) 112 

Peritonitis 112 

Pleurisy 113 

Pneumonia 114 

Ptomaine  poisoning 116 

Rickets 117 

Ringworm 120 

Rheumatism 120 

Scarlet  fever 122 

Scrofula 123 

Scurvy 125 

Smallpox 126 

Sore  throat 129 

Stomatitis 130 

Sweating 130 

Syphilis 131 

Suppuration  of  the  ear 134 

Teething  in  infancy 137 

Teeth 138 

Thrush 138 

Tonsillitis 139 

Toothache 140 

Tuberculosis  of  the  lung 140 

Tuberculosis  of  the  spine 147 

Tuberculosis  of  the  glands 148 

Typhoid  fever    148 

Ulcers 150 

Ulcer  of  the  stomach 153 

Vaccination 126 

Vomiting 153 

Whooping  cough 155 


6  MEDICAL   HANDBOOK. 

Chapter  XI.  Practice  of  medicine — Continued.  Page. 

Women's  diseases 156 

Worms,  intestinal 161 

Wounds 162 

Chapter  XII.  Ventilation 165 

Chapter  XIII.  Quarantine  and  disinfection 170 

Chapter  XIV.  Natural  self -protection 1 75 


PEEFAOE. 

This  book  is  written  especially  for  the  teachers 
of  the  Alaska  school  service,  and  pains  have  been 
taken  to  describe  the  symptom  and  outline  the 
treatment  of  the  common  diseases  of  the  natives 
in  simple,  plain  language. 

In  Alaska  there  are  large  areas  in  which  the 
services  of  a  physician  are  not  obtainable,  and  it 
often  becomes  the  duty  of  the  teacher  not  only  to 
render  first  aid  to  an  injured  or  sick  native,  but 
to  care  for  him  through  the  entire  course  of 
severe  illness  without  the  aid  of  a  physician. 

^'A  little  learning  is  a  dangerous  thing,"  and 
this  is  especially  true  in  medicine.  Teachers  are 
warned  to  be  careful  in  prescribing.  It  is  often 
difficult  to  make  a  diagnosis  of  the  disease  with 
which  the  patient  is  suffering.  To  lessen  this 
difficulty,  a  chapter  on  symptoms  has  been  pre- 
pared, which  will  be  of  assistance  in  determining 
any  case. 

Study  this  book  carefully  and  remember  that 
all  doses  given  in  it  are  for  adults  unless  otherwise 
specified.    The  proper  dose  for  a  child  can  be 

7 


MEDICAL  HANDBOOK. 


ascertained  by  referring  to  Young's  rule,  fully- 
described  on  p.  14. 

In  conclusion,  remember  that  this  handbook 
is  not  intended  to  replace  the  services  of  a  physi- 
cian, and  all  cases  should  be  referred  to  one 
wherever  possible. 

Hughes's  Practice  of  Medicine,  which  is  found 
in  every  school  library,  will  give  you  further 
details  of  any  disease  which  may  occur. 


MEDICAL  HANDBOOK. 


CHAPTER  I. 

PREPARATIONS,  WEIGHTS  AND  MEASURES. 


Some  of  the  official  preparations  of  the  United 
States  Pharmacopoeia  are  here  given: 
Alkaloids  are  natural  principles  existing  in  plants 

and  extracted  by  chemical  art. 
Aqua  is  a  watery  solution  of  volatile  substances. 
Elixirs  are  pleasant-tasting  alcoholic  solutions 

of  active  drugs. 
Emulsions  are  preparations  which  contain  oil 

in  a  state  of  suspension. 
Extracts,  Fluid,  are  alcoholic  concentrated  tinc- 
tures of  vegetable  drugs. 
Glycerites  are  mixtures  of  medicinal  substances 

with  glycerin. 
Liniments  are  oily  preparations  for  external  use 

with  friction,  made  by  dissolving  various 

drugs  in  oily  liquids. 
Mixtures  are  aqueous  preparations  of  insoluble 

substances,  held  in  suspension  by  a  suitable 

vehicle. 

9 


10  MEDICAL  HANDBOOK. 

Ointments  are  soft,  fatty  mixtures  of  medicinal 
agents  with  a  basis  of  lard,  petroleum,  or 
fixed  oils,  intended  for  application  to  the 
skin  by  rubbing. 

Pills  are  small  spherical  masses  composed  of 
medicinal  agents  and  intended  to  be  swal- 
lowed whole. 

Powders  are  dry  substances  reduced  to  fine 
particles. 

Spirits  are  alcoholic  preparations  of  volatile 
drugs. 

Suppositories  are  solid  bodies  consisting  of  me- 
dicinal substances  incorporated  with  Cacao 
butter  and  intended  for  introduction  into 
the  rectum  or  vagina. 

Sirups  are  concentrated  solutions  of  sugar  in 
water  with  soluble  medicinal  substances. 

Tablets  are  small,  flat  medicated  cakes. 

Compressed  Tablets  are  large  medicated 
cakes  made  usually  to  be  dissolved  be- 
fore administration. 

Tinctures  are  alcoholic  solutions  of  nonvolatile 
drugs. 

Troches,  Tablets,  or  Lozenges  are  small  flattened 
cakes  consisting  of  medicinal  substances  in- 
corporated with  sugar,  mucilage,  etc. 


PREPARATIONS,  WEIGHTS  AND  MEASURES.  11 

WEIGHTS  AND  MEASURES. 

The  amount  of  each  drug  in  a  prescription  is 
expressed  in  grains,  scruples,  drachms,  ounces, 
and  pounds;  or,  if  it  be  a  Hquid,  in  minims, 
drachms,  ounces,  pints,  etc. 
1  ounce  =  480  grains. 
1  ounce  =  8  drachms. 
1  drachm  =  60  grains. 
1  drachm  =  3  scruples. 
1  pound  =  12  Troy  ounces. 
1  minim  =  1  drop  (water) . 
1  fluid  ounce  =  8  fluid  drachms. 
1  pint  =  16  fluid  ounces. 
1  gallon  =  8  pints. 
Teaspoonful  =  1  drachm. 
Teaspoonful  =  60  minims  or  drops. 
Table  spoonful  =  4  drachms. 
Table  spoonful  =  J  ounce. 
Teacup  =  4  ounces. 
Dessertspoonful  =  2  drachms. 
Wineglassful  =  1 J  to  2  ounces. 
Glass  =  8  to  10  ounces. 
1  fluid  ounce  =  2  tablespoonfuls. 
1  fluid  ounce  =  8  teaspoonfuls. 
1  fluid  ounce  =  480  minims. 


CHAPTER  n. 
DRUGS— PHYSIOLOGICAL  ACTIONS,  DOSES. 


Ammonia  Spirit,  Aromatic — stimulant,  expec- 
torant, antacid;  20  to  60  drops. 

Bismuth  Subnitrate — sedative  to  mucous  mem- 
branes; 10  to  30  grains. 

Brown  Mixture — expectorant;  1  to  2  teaspoon- 
fuls. 

Calomel — purgative;  J  to  2  grains. 

Castor  Oil — laxative;  1  to  4  teaspoonfuls. 

Elixir  Heroin  and  Terpin  Hydrate — sedative, 
cough  mixture;  1  teaspoonful. 

EUxir  of  Iron,  Quinine,  and  Strychnine — tonic; 
1  teaspoonful. 

Extract  Cascara  Sagrada,  Aromatic — laxative, 
cathartic;  15  drops  to  1  teaspoonful. 

Creosote — antiseptic  alterative;  1  to  5  drops. 

Chloranodyne — antispasmodic  and  sedative;  5 
to  15  drops. 

Codeine  (an  alkaloid  of  opium) — sedative;  J  to 
i  of  a  grain. 

Cod-Liver  Oil — nutrient  tonic;  1  to  8  teaspoon- 
fuls. 

12 


DRUGS,  ACTIONS  AND  DOSES.  13 

Dover's  Powder — expectorant,  sedative;  2  to  10 

grains. 
Ergot  Fluid  Extract — antihemorrhagic;  10  to  60 

drops. 
Iodide  of  Mercury — antisyphilitic;   g  to  1  grain. 
Iodine    Tincture — alterative,   counter    irritant; 

for  external  use  only. 
Iron  Tincture — alterative  tonic;  5  to  15  drops 

in  water. 

Iron  Iodide  Sirup — alterative  tonic;  10  drops  to 
1  teaspoonful. 

Ipecac  Wine — expectorant  and  emetic;  1  tea- 
spoonful. 

Magnesium  Sulphate  (Epsom  Salts) — cathartic; 
1  to  4  tablespoonfuls. 

Morphine  (alkaloid  of  opium) — ^narcotic;  J  to  J 
of  a  grain. 

Tinctture  Opiiun  Camphorated  (paregoric) — anti- 
spasmodic, narcotic;  3  to  15  drops. 

Pill  Cathartic  Compound — cathartic;  1  to  2  pills. 

Potassium  Bromide — sedative;  5  to  30  grains. 

Potassium  Iodide — alterative;  5  to  30  grains. 

Protiodide  of  Mercury — antisyphilitic;  g  to  1 
grain. 

Quinine  Sulphate — antipyretic,  tonic;  1  to  3 
grains. 


14  ,       MEDICAL.  HANDBOOK. 

Sirup  Hypophosphites  Compound — tonic;    1  to 

2  teaspoonfuls. 
Salol  and  Phenacetin^ — antipyretic,  analgesic;  1 

to  2  tablets. 
Salol — intestinal  and  urinary  antiseptic;  5  to  10 

grains. 
Sodium  Bicarbonate — antacid;  5  to  60  grains. 
Sodium  Salicylate — antirheumatic;  5  to  20  grains. 
Strychnine  Sulphate — stimulant,  tonic;  go  of  a 

grain. 
Sweet  Spirits  of  Niter — antipyretic  and  diuretic ; 

10  to  60  drops. 
Zinc  Sulphocarbolate — intestinal,  antiseptic;  J 

to  2  grains. 
Viburnum  Extract  Fluid — uterine  tonic;  J  to  1 

teaspoonful. 

DOSES  FOR  CHILDREN. 

The  doses  of  drugs  given  on  the  foregoing  pages 
are  for  adults.  For  children  the  following  rule 
(Young's)  will  he  found  most  convenient: 

Add  12  to  the  age  and  divide  by  the  age;  thus  for 
a  child  2  years  old,  2  plus  12  equals  14;  divide  by 
age  given  (2)  and  the  dose  is  one-seventh  of  the 
adult  dose. 


CHAPTER  III. 
THERAPEUTIC  USES  OF  DRUGS. 


ACID,  BORIC. 

A  valuable  antiseptic,  as  it  causes  no  irritation 
to  the  tissues;  it  is  largely  used  as  a  dusting 
powder  for  wounds,  ulcers,  etc.,  and  in  solution  of 

1  teaspoonful  to  8  or  10  ounces  of  water  as  a 
wash  in  diseases  of  the  eyes,  ears,  and  mouth. 

ACID,  CARBOLIC  (POISONOUS). 

Carbolic  acid  is  largely  used  externally,  and  as 
a  deodorant  and  disinfectant  for  soiled  linen, 
bedpans,  closets,  drains,  etc.     In  solution  of  1  or 

2  teaspoonfuls  to  16  ounces  of  water  it  is  often 
employed  for  washing  wounds,  ulcers,  and  for 
disinfecting  surgical  instruments. 

CARBOLIZED  VASELINE. 

Is  used  as  an  emollient  in  eruptive  fevers,  to 
allay  irritation  of  the  skin,  and  to  prevent  the 
dried  scaly  particles  from  spreading.  It  has 
also  antiseptic  power. 

15 


16  MEDICAL  HANDBOOK. 

BICARBONATE  OF  SODA  (BAKING  SODA). 

An  efficient  household  remedy  for  heartburn, 
indigestion,  etc.,  in  doses  of  from  J  to  J  teaspoon- 
ful  dissolved  in  half  a  glass  of  hot  water.  It  is 
an  invaluable  remedy  for  burns;  mix  with 
water  to  the  consistency  of  paste  and  apply  to 
the  burned  surface,  or  moisten  the  burned  sur- 
face and  dust  thickly  with  soda. 

Dissolved  in  water  and  applied,  it  affords  re- 
lief for  insect  bites. 

ARGYROL. 

In  solution  of  from  5  to  10  per  cent  it  is  often 
used  in  inflammatory  and  purulent  diseases  of 
the  eyes.  It  should  be  dropped  into  the  eyes 
from  a  scrupulously  clean  glass  dropper  3  or  4 
times  a  day.  Take  care  not  to  drop  on  the 
clothing,  as  it  leaves  yellow  stains,  which,  how- 
ever, may  be  removed  by  sponging  with  a  solu- 
tion of  Bichloride  of  Mercury.  The  best  results 
are  obtained  from  freshly  prepared  solutions  of 
Argyrol.  As  this  drug  is  expensive,  avoid  waste 
and  never  prepare  more  than  J  ounce  at  a  time. 

BICHLORIDE  OF  MERCURY  TABLETS. 

These  antiseptic  tablets  are  never  used  other- 
wise than  externally,  and  never  in  stronger  so- 
lution than  1  to  1,000  (that  is,  one  tablet  of  7t^ 


THERAPEUTIC  USES  OF  DRUGS.  17 

grains  to  1  pint  of  water) .  As  the  tablets  differ 
in  strength,  read  carefully  the  directions,  which 
are  usually  printed  on  the  label  of  the  bottle. 

Bichloride  makes  an  excellent  wash  for  ulcers 
and  wounds,  also  for  disinfecting  the  hands 
either  before  or  after  operating,  dressing  wounds, 
or  touching  infectious  or  pus  cases. 

As  Bichloride  of  Mercury  is  easily  absorbed  by 
the  skin  and  mucous  membrane  and  is  liable  to 
produce  poisoning,  use  with  caution.  Never 
use  it  for  sterilizing  metal  instruments,  as  it  cor- 
rodes them. 

BISMUTH  SUBNITRATE. 

It  is  often  applied  externally  in  the  form  of 
powder  or  ointment  to  inflamed  areas,  as  in 
chapped  nipples,  ulcers,  and  eczema.  Bismuth 
is  a  mild  sedative  and  astringent.  Internally 
it  is  useful  in  vomiting,  pain  in  the  stomach, 
catarrh  of  the  stomach,  and  gastric  ulcers.  The 
astringent  influence  of  Bismuth  on  the  intestines 
makes  it  a  valuable  remedy  for  diarrhea,  espe- 
cially in  children.  Little  or  no  effect  is  to  be  ex- 
pected from  less  than  20  grains  for  adults,  or  5 
grains  for  children.  These  doses  may  be  in- 
creased with  perfect  safety. 

77037°— 1:3 2 


18  MEDICAL  HANDBOOK. 

BROWN  MIXTURE. 

Brown  Mixture  is  a  compound  which  contains 
expectorants  and  a  small  amount  of  Camphor- 
ated tincture  of  opium  (paregoric).  It  makes 
an  excellent  cough  remedy,  especially  for  infants 
and  children,  in  colds,  bronchitis,  etc.  The 
liquid  form  is  most  suitable  for  infants  and  small 
children.  The  tablets,  which  may  be  easily 
carried,  are  very  convenient  for  adults.  Dose 
for  children,  from  5  drops  to  1  teaspoonful 
(according  to  age)  every  2  or  3  hours.  Dose  for 
adults,  1  to  2  tablets  every  3  hours. 

CALOMEL. 

It  is  used  externally  as  a  dusting  powder  for 
syphihtic  sores  and  in  eye  diseases.  Internally 
it  is  a  valuable  purgative,  possessing  also  the 
property  of  an  intestinal  disinfectant,  in  doses 
of  from  4  of  a  grain  to  2  grains. 

It  is  largely  used  in  biliousness,  in  doses  of 
J  of  a  grain  every  half  hour  until  2  grains  are 
taken.  Follow  by  Epsom  salts  (J  ounce)  at  the 
end  of  3  or  4  hours. 

For  children  who  are  "under  the  weather" 
and  never  quite  well,  who  have  fetid  breath  and 
ill-smelling  pasty  stools,  calomel  often  gives 
relief;  t^  of  a  grain  every  half  hour  until  4  doses 
are  taken.  This  treatment  is  repeated  every 
fourth  or  fifth  morning. 


THERAPEUTIC  USES  OF  DRUGS.  19 

CASCARA  SAGRADA  (FLUID  AROMATIC). 

Is  a  laxative  in  small  doses  and  a  cathartic 
in  large  doses.  Its  pleasant  taste  and  non- 
griping  effect  make  it  very  suitable  for  infants, 
children,  and  the  aged.  Dose,  15  drops  (for  in- 
fants) to  1  teaspoonful  for  adults. 

In  cases  of  hemorrhoids  (piles)  with  constipa- 
tion, it  is  the  most  suitable  remedy. 

CASCARA  COMPOUND  PILLS. 

Are  used  where  stronger  action  is  required. 
Dose,  from  1  to  2  pills  at  night.  (The  pills  are 
more  convenient  to  carry.) 

CASTOR  OIL. 

Is  a  simple  laxative,  rapid,  certain,  and  mild, 
producing  one  or  more  semisolid  stools  in  4  to 
6  hours.  Its  only  disadvantage  lies  in  its 
unpleasant  taste.  It  is  the  best  of  all  simple 
purgatives  when  only  free  evacuation  of  the 
bowels  is  desired.  It  may  be  given  in  all 
diseases  where  a  laxative  is  permissible,  and  is 
therefore  especially  employed  in  the  treatment 
of  diarrhea  due  to  the  presence  of  indigestible  or 
undigested  food  in  the  bowels.  It  is  the  most 
valuable  purgative  for  children.  At  the  same 
time,  it  must  not  be  used  as  a  routine  purge,  as 
its  prolonged  use  causes  constipation. 

Dose,  from  1  teaspoonful  to  2  tablespoonfuls. 


20  MEDICAL  HANDBOOK. 

CHLORANODYNE, 

Is  a  mixture  consisting  of  strong  narcotics, 
such  as  Cannabis  Indica,  Morphine,  etc.;  there- 
fore it  should  be  used  cautiously,  as  an  overdose 
may  cause  death. 

It  is  a  valuable  remedy  in  stomach  and  intes- 
tinal colic  in  the  adult,  or  in  cases  of  intense 
abdominal  pain  of  obscure  origin.  Full  dose 
(for  adults)  j  10  to  15  drops,  to  be  repeated  in 
15  minutes,  only  if  necessary. 

CODEINE. 

Codeine  is  an  alkaloid  of  opium.  It  is  used 
for  cases  with  excessive  cough  and  pain.  It 
should  never  be  given  continuously  for  any 
length  of  time,  as  it  is  liable  to  cause  the  Codeine 
habit.     It  must  never  be  given  to  children. 

Dose,  from  J  to  J  of  a  grain. 

COD-LIVER  OIL. 

Cod-liver  oil  is  an  easily  digested,  nutrient  oil. 
During  its  use  there  is  usually  an  increase  of  red 
corpuscles  and  of  bodily  weight.  It  is  the  most 
useful  of  all  tonics  for  young  children,  but  should 
be  given  with  discretion,  or  it  may  disagree. 
It  should  not  be  ordered  if  there  are  signs  of 
dyspepsia,  or  if  its  administration  interferes 
with  the  child's  appetite  or  digestion. 


THERAPEUTIC  USES  OF  DRUGS.  21 

It  is  extensively  used  in  all  wasting  diseases, 
such  as  scrofula,  advanced  stages  of  syphilis, 
tuberculosis,  chronic  bronchitis,  rachitis,  and 
general  debility  due  to  overwork  and  under- 
feeding. 

Dose,  from  1  teaspoonful  to  2  tablespoonfuls 
after  meals. 

CREOSOTE. 

Creosote  is  used  internally  as  a  disinfectant  and 
deodorant  in  tuberculosis,  chronic  bronchitis, 
gangrene,  and  other  diseases  of  the  lungs  attend- 
ed with  foul  discharges.  It  occasionally  proves 
useful  in  some  forms  of  vomiting  and  diarrhea 
due  to  bacterial  decomposition  in  the  intestines. 
The  specific  action  of  this  drug  depends  on  the 
fact  that  it  has  power  to  destroy  low  vegetable 
organisms. 

Dose,  from  1  to  3  drops. 

DOVER'S  POWDER. 

Each  10  grains  contains  1  grain  of  powdered 
opium  (iV  grain  Morphine).  It  produces  pro- 
fuse sweating,  relieves  pain,  and  checks  diarrhea. 
It  is  largely  used  for  breaking  up  colds,  in  severe 
cases  of  pleurisy,  and  in  cases  where  the  cough 
is  very  troublesome. 


22  MEDICAL  HANDBOOK. 

Dose  for  children,  from  1  to  2  grains.  Dose 
for  adults,  5  to  10  grains,  to  be  repeated  if 
necessary. 

ELIXIR  IRON,  QUININE,  AND  STRYCHNINE. 

Is  an  excellent  compound,  having  a  tonic 
effect.  Used  largely  in  anemia,  loss  of  appetite, 
loss  of  strength,  nervous  breakdown,  con- 
valescence, etc. 

Dose  for  adults,  1  teaspoonful  3  times  a  day 
before  meals.  Dose  for  children,  from  10  drops 
to  J  teaspoonful. 

ELIXIR  HEROIN  AND  TERPIN  HYDRATE. 

Is  a  cough  mixture  of  great  value  in  far- 
advanced  tubercular  cases,  but  as  it  contains 
Heroin,  which  is  an  alkaloid  of  opium,  it  should 
never  be  dispensed  for  children. 

Dose,  i  to  1  teaspoonful  in  plenty  of  water 
every  3  or  4  hours. 

EPSOM  SALTS. 

An  excellent  saline  purgative,  causing  free, 
watery  evacuations  of  the  bowels;  because  of  its 
rapid  action  it  should  always  be  prescribed 
where  a  speedy  movement  of  the  bowels  is 
desirable.  As  Epsom  salts  neutralizes  the  ex- 
cessive acidity  of  the  stomach  and  bowels,  and 


THERAPEUTIC  USES  OF  DRUGS.  23 

prevents  the  formation  of  gas,  it  is  a  most 
valuable  purgative  in  diseases  of  the  stomach, 
intestines,  and  abdomen.  It  is  often  used  in 
Bright's  disease,  because  of  its  diuretic  effect 
on  the  kidneys.  It  also  neutralizes  overacidity 
of  the  urine. 

Should  the  patient,  owing  to  irritability  of  the 
stomach,  be  unable  to  retain  Epsom  salts,  it  may 
be  given  as  an  enema,  an  ounce  or  two  being 
dissolved  in  about  1  pint  of  warm  water  and 
injected  into  the  rectum  (this  enema  should  be 
retained  as  long  as  possible).  Epsom  salts 
should  not  be  used  regularly  as  a  physic;  its 
continuous  use  is  liable  to  cause  constipation. 

Dose,  from  1  to  4  tablespoonfuls  1  hour 
before  meals. 

ERGOT,  FLUID  EXTRACT. 

Ergot  is  only  used  to  cause  contraction  of  the 
uterus  and  control  hemorrhage  following  child- 
birth or  in  cases  of  excessive  monthly  flow. 

Dose,  15  drops  to  1  teaspoonful,  to  be  repeated 
if  necessary  in  2  or  3  hours. 

HYDROGEN  PEROXIDE. 

A  powerful  oxydizing  agent,  possessing  bleach- 
ing and  disinfecting  qualities.  It  is  chiefly  used 
in  treatment  of  abscess  cavities.     In  diphtheria 


24  ilEDICAIi  HANDBOOK. 

and  tonsillitis  it  is  used  as  a  gargle,  spray,  or 
mouthwash.  It  is  usually  diluted  with  equal 
parts  of  water,  but  may  safely  be  used  pure. 

ICHTHYOL. 

Ichthyol  is  generally  used  externally,  in  the 
form  of  ointments  to  be  applied  on  inflamed 
surfaces.  It  not  only  has  antiseptic  power,  but 
relieves  pain  when  used  in  erysipelas  and  vari- 
ous inflammatory  diseases  of  the  skin.  It  is  of 
great  value  for  caked  or  inflamed  breasts,  etc. 
Ichthyol  is  the  best  all-round  ointment. 

IODOFORM. 

A  valuable  antiseptic  and  disinfectant,  used 
locally  in  dressing  ulcers  and  wounds.  Iodo- 
form ma}''  be  absorbed  through  the  wounded  or 
ulcerated  surface,  causing  skin  eruption  and 
vomiting.  In  these  cases  its  use  should  be 
instantly  discontinued.  In  using  Iodoform  it  is 
good  policy  to  dust  it  on  as  lightly  as  possible, 
and  never  use  on  a  very  large  surface,  as  poison- 
ing is  liable  to  occur. 

MORPHINE. 

Morphine  is  a  dangerous  and  habit-forming 
drug,  and  should  not  be  used  except  as  directed 
in  this  book.     Its  administration  should  be  at- 


THERAPEUTIC  USES  OF  DRUGS.  25 

tended  with  great  caution,  and  it  should  never 
be  given  to  children. 

Morphine  in  doses  of  J  grain  (for  adults) 
stops  pain,  produces  sweat,  and  checks  diarrhea. 
The  dose  must  not  be  repeated  except  in  case  of 
absolute  necessity.  It  must  never  be  used  if  the 
patient  suffers  from  any  form  of  kidney  trouble, 
as  it  checks  the  secretion  of  urine.  If  quick 
action  is  desired,  or  if  the  stomach  is  upset,  it 
may  be  given  hypodermically. 

POTASSIUM  BROMroE. 

A  valuable  remedy,  especially  for  children,  if 
carefully  used.  It  is  invaluable  in  convulsions 
of  babies,  caused  by  teething;  in  whooping 
cough,  sleeplessness,  nervousness,  and  in  different 
forms  of  nervous  affections.  It  is  often  used  for 
adults  to  quiet  hysterical  attacks,  and  some- 
times gives  great  relief  in  the  vomiting  of 
pregnancy. 

Dose  for  adults,  10  to  30  grains  every  3  or  4 
hours  till  relieved.  Under  ordinary  circum- 
stances from  1  to  2  grains  every  2  or  3  hours  may 
be  given  to  infants  of  a  month  or  two  old,  while 
children  of  1  year  or  more  may  have  3  to  5 
grains  at  similar  intervals. 

It  is  well  to  remember  that  when  bromides  are 
given  to  babies  a  pustular  rash  may  appear,  even 


26  MEDICAL  HANDBOOK. 

after  very  small  doses.  Potassium  Bromide  be- 
fore being  administered  should  always  be  thor- 
oughly dissolved  either  in  water  or  in  sirup. 

POTASSIUM  IODIDE. 

Is  used  principally  in  the  secondary  and  ter- 
tiary stages  of  syphilis,  and  sometimes  in  chronic 
rheumatism.  Its  continued  use  may  produce 
unpleasant  symptoms  known  as  "iodism,"  con- 
sisting of  watery  discharge  from  the  nose,  sneez- 
ing, severe  headache,  swelling  and  redness  of  the 
gums  and  palate,  and  increased  flow  of  saliva. 
If  these  symptoms  occur,  its  use  should  be  dis- 
continued for  a  short  time.  In  some  individuals 
it  produces  a  pustular  eruption  of  the  skin. 

Dose,  from  5  to  30  grains  dissolved  in  half  a 
glass  of  water  three  times  a  day  (after  meals) . 

When  giving  Potassium  Iodide  be  sure  that 
the  patient's  bowels  move  daily,  and  insist  that 
the  teeth  and  gums  be  kept  clean. 

QUININE. 

Quinine  lowers  the  bodily  temperature  in  all 
septic  fevers.  It  may  be  used  with  good  results 
in  malaria,  influenza,  pneumonia,  pleurisy,  phar- 
yngitis, neuralgia,  and  headache,  if  periodical  in 
its  appearance. 


THERAPEUTIC  TJSES  OF  DRUGS.  27 

In  small  doses  it  improves  the  appetite  and 
digestion,  and  increases  bodily  strength.  On 
this  account  it  is  largely  used  during  convales- 
cence in  combination  with  iron  and  strychnine 
in  the  form  of  Elixir  iron,  quinine,  and  strych- 
nine. Quinine  is  one  of  the  drugs  which  chil- 
dren bear  well.  An  overdose  causes  ringing  of 
the  ears  and  dimness  of  vision. 

Adult  dose,  from  1  to  3  grains.  Dose  for  chil- 
dren, from  J  grain  to  1  grain. 

SALOL. 

An  active  intestinal  antiseptic;  it  also  has  the 
property  of  disinfecting  the  genito-urinary  tract. 
Continued  use  of  it  will  color  the  urine  green  or 
black.  It  is  often  used  in  combination  with 
Phenacetin  as  an  antipyretic.  Salol  is  largely 
used  in  diarrheas,  intestinal  fermentation,  and 
gonorrhea,  and  is  an  efficient  remedy  in  cases  of 
chronic  rheumatism. 

Dose  for  adults,  from  5  to  10  grains. 

SODIUM  SALICYLATE. 

Is  particularly  valuable  in  all  forms  of  acute 
rheumatism,  especially  articular;  also  in  tonsil- 
litis. It  is  sometimes  used  in  neuralgia  and 
fevers.     In  large  continuous  doses  it  causes  ex- 


28  MEDICAL  HANDBOOK. 

treme  sweating,  fullness  in  the  head,  ringing  in 
the  ears,  and  may  upset  the  stomach. 
Adult  dose,  from  5  to  15  grains. 

SPIRITS  OF  NITROUS  ETHER. 

(Sweet  spirit  of  nitre.) 

A  common  remedy  for  diseases  of  the  urinary 
organs,  such  as  painful  urination,  pain  in  the 
bladder  from  taking  cold,  etc.  It  will  usually 
increase  the  flow  of  urine,  relieve  abdominal  pain, 
produce  perspiration,  reduce  the  temperature  in 
fevers,  and  often  relieves  pain  of  the  heart  in 
Bright's  disease. 

Dose  for  adults,  from  15  drops  to  J  teaspoonful, 
well  diluted  with  water. 

SPIRITUS  AMMONIA  AROMATIC. 

An  aromatic,  alcoholic  compound,  extensively 
used  for  stimulating  the  heart  and  respiratory 
tract.  It  is  ordinarily  given  in  collapse,  faint- 
ness,  shortness  of  breath,  and  sudden  heart  fail- 
ure. It  is  an  excellent  expectorant  in  pneu- 
monia and  bronchitis;  it  is  sometimes  used  to 
neutralize  acidity  of  the  stomach. 

Dose  for  adults  as  expectorant,  from  5  to  15 
drops.  As  a  stimulant  from  J  teaspoonful  to  1 
teaspoonful  in  water. 


THERAPEUTIC  USES  OF  DRUGS.  2f9 

STRYCHNINE  SULPHATE. 

Is  prepared  from  Nux  Vomica,  and  is  a  great 
heart  and  respiratory  stimulant.  It  is  one  of 
the  remedies  that  often  prolongs  life,  especially  in 
fevers  where  the  patient  has  become  weak. 

Dose  for  adults,  ^  of  a  grain.  If  an  over- 
dose is  given  it  produces  convulsions.  So  if  you 
notice  any  twitchings  of  the  muscles  after  it  has 
been  given  for  some  time  discontinue  its  use. 
For  immediate  action  it  should  be  given  hypo- 
dermically. 

SIRUP  HYPOPHOSPHITES. 

Used  in  cases  of  general  debility  and  in  diseases 
of  the  nervous  system,  because  of  its  valuable 
reconstructive  properties.  Especially  suitable 
in  tuberculosis,  chronic  bronchitis,  rachitis,  and 
scrofula. 

Dose  for  adults,  1  to  2  teaspoonfuls.  It  is 
well  borne  by  children,  and  may  be  given  in  doses 
of  from  I  to  1  teaspoonful. 

SIRUP  IRON  IODIDE. 

An  alterative,  possessing  qualities  similar  to 
those  of  Potassium  Iodide.  It  is  well  tolerated 
by  children,  and  is  therefore  much  used  in 
hereditary  syphilis  and  scrofula. 


30  MEDICAL  HANDBOOK. 

Dose  for  adults,  J  to  1  teaspoonful.  For 
children,  5  to  15  drops. 

TINCTURE  IRON  CHLORIDE. 

A  very  useful  drug  in  anemia,  as  it  increases 
the  iron  in  the  red  blood  cells  and  stimulates  the 
heart,  nerves,  and  muscular  activity.  As  all 
preparations  of  iron  are  very  constipating,  keep 
the  bowels  of  the  patient  open  with  a  saline 
laxative.  Iron  discolors  the  teeth,  so  it  should 
be  taken  through  a  glass  tube  and  the  mouth 
rinsed  well  afterward. 

Dose  for  adults,  from  5  to  15  drops;  for  chil- 
dren, from  2  to  5  drops. 

MERCURY  PROTIODIDE. 

This  drug  is  used  chiefly  in  syphilis  in  doses  of 
from  i  to  1  grain.  As  Mercury  is  very  irri- 
tating to  the  stomach,  and  frequently  causes 
salivation,  watch  its  effects  carefully,  and  discon- 
tinue its  use  for  a  short  period  if  necessary. 

Keep  the  mouth  and  teeth  clean  and  well 
scrubbed,  and  see  that  the  bowels  move  regu- 
larly. 

MERCURIAL  OINTMENT. 

,    Used  as  an  inunction  in  syphilitic  affections. 

SULPHUR  OINTMENT. 

A  specific  for  scabies  or  itch. 


THERAPEUTIC  USES  OF  DRUGS.  31 

TINCTURE  IODINE. 

Is  employed  as  a  counterirritant  by  painting 
over  the  skin,  in  pleurisy,  chronic  rheumatism, 
enlarged  lymphatic  glands,  chilblains,  and  ery- 
sipelas. It  is  painful  when  applied  to  raw  sur- 
faces. Tincture  Iodine  possesses  strong  anti- 
septic properties. 

TINCTURE  OPIUM  CAMPHORATED  (PAREGORIC.) 

Is  extensively  used  in  cough  and  diarrhea 
mixtures,  but  must  be  used  with  great  care,  as 
infants  and  children  are  very  susceptible  to  its 
action.  It  must  never  be  given  to  quiet  ordi- 
nary restlessness  or  produce  sleep. 

Dose  for  adults,  from  5  to  30  drops;  for  in- 
fants, from  1  to  2  drops;  for  older  children,  from 
2  to  5  drops. 

VIBURNUM  COMPOUND. 

An  aromatic  mixture  much  used  as  an  astrin- 
gent, tonic,  and  sedative  in  all  uterine  diseases. 

Dose  for  adults,  1  teaspoonful  in  J  glass  of 
sweetened  hot  water  every  3  hours. 

WINE  OF  IPECAC. 

An  excellent  emetic  and  expectorant,  espe- 
cially valuable  when  it  is  found  necessary  to 
empty  the  stomach  of  undigested  food,  and  in 


32  MEDICAL  HANDBOOK. 

croup  and  bronchitis  when  it  is  advisable  by  the 
act  of  vomiting  to  clear  the  upper  air  passages. 
Dose  for  adults  and  children  as  emetic,  1  tea- 
spoonful  repeated  in  5  to  10  minutes  till  vomiting 
occurs.     As  an  expectorant,  from  2  to  5  drops. 

ZINC  OXIDE  OINTMENT. 

Astringent  and  soothing.  It  is  commonly 
used  as  an  application  to  slowly  healing  wounds, 
ulcers,  and  various  skin  affections. 

ZINC  SULPHOCARBOLATE. 

In  moderate  doses  arrests  fermentation  in  the 
stomach  and  intestines  and  acts  as  an  astringent. 
It  is  used  mostly  in  diarrhea  and  cholera 
infantum. 

Dose  for  adults,  J  grain  to  2  grains;  dose  for 
children,  J  grain  to  1  grain. 


CHAPTER  IV. 
THE  ADMINISTRATION  OF  DRUGS. 


The  doses  of  all  drugs  given  in  this  book  are, 

unless  otherwise  stated,  full  doses  for  adults. 

.The  doses  for  children  should  be  from  one-half  to 

one-seventh  of  the  adult  dose,  according  to  the 

age.     (See  p.  19.) 

The  drugs  supplied  in  tablet  form  should  al- 
ways be  dissolved  in  water  before  being  adminis- 
tered to  children. 

As  children  do  not  stand  opium  well,  be  espe- 
cially careful  with  such  preparations  as  Heroin, 
Codeine,  Morphine,  Dover's  powder,  or  any  prep- 
aration containing  opium  in  any  form ;  when  ad- 
ministering, use  great  caution  and  never  give  for 
the  purpose  of  producing  sleep. 

In  all  acute  diseases,  drugs  are  to  be  given 
without  regard  to  the  time  of  eating.  Where 
medicine  is  prescribed  3  times  a  day,  it  is  best  to 
give  after  meals. 

In  rectal  injections  (enemata),  warm  water 
may  be  used  with  the  addition  of  soap,  Epsom 
salts,  olive  oil,  or  glycerin.     Have  the  patient 

77037°— 13 3  33 


34  MEDICAL  HANDBOOK. 

lie  on  the  left  side  with  the  hips  slightly  elevated. 
The  fluid  should  be  warm,  about  blood  heat,  and 
in  quantity  not  exceeding  2  pints  at  one  time. 
Food  can  be  administered  through  the  rectum 
in  cases  of  gastric  ulcers  and  different  abdominal 
and  stomach  obstructions  and  severe  vomiting. 
Milk  and  beef  juice,  preferably  with  pepsin,  are 
the  most  suitable  fluids.  Never  give  more  than 
6  ounces  at  one  time  and  administer  3  to  4  times 
a  day. 

HYPODERMIC  INJECTIONS. 

The  hypodermic  method  of  medication  is  used 
in  all  cases  in  which  immediate  results  are  to  be 
obtained.  The  following  details  should  be  care- 
fully observed : 

The  syringe  should  be  scrupulously  clean,  and 
the  needle  sterilized  by  passing  through  an  alco- 
hol (or  other)  flame.  The  use  of  a  dirty  syringe 
or  needle  is  very  liable  to  cause  an  abscess.  The 
piston  of  the  syringe  should  be  air  tight.  The 
point  of  the  needle  should  be  sharp.  Care  should 
be  taken  to  expel  all  air  from  the  syringe  and 
needle  before  using.  This  is  accomplished  by 
holding  the  loaded  syringe  in  an  upright  posi- 
tion, with  the  needle  pointing  upward,  slowly 
pressing  the  piston  to  expel  two  or  three  drops 
of  the  solution.     Then  insert  the  needle  of  the 


ADMINISTRATION  OF  DRUGS.  35 

syringe  beneath  the  skin,  which  has  been  previ- 
ously carefully  cleaned  with  soap  and  water, 
followed  by  alcohol.  Be  careful  not  to  insert 
the  needle  directly  into  a  blood  vessel.  Push 
the  piston  gradually  home;  withdraw  the  needle 
and  press  the  finger  over  the  puncture  to  prevent 
the  return  of  the  fluid.  The  fleshy  part  of  the 
arms  is  the  most  convenient  place  for  an  injec- 
tion. 

Only  hypodermic  tablets  should  be  used  in 
the  hypodermic  syringe.  Take  one  tablet  and 
dissolve  in  15  drops  of  water  (in  a  teaspoon) 
and  boil. 


CHAPTER  V. 
FOOD  FOR  THE  SICK. 


The  food  for  the  sick  should  be  prepared  from 
fresh  milk  and  beef,  where  obtainable.  Liquid 
food  is  always  preferable,  as  it  is  easily  assimi- 
lated by  the  system  and  is  less  irritating  to  the 
stomach.  Always  add  a  small  amount  of  lime 
water  (two  teaspoonfuls  to  each  glass)  to  con- 
densed milk  and  cream,  which  should  be  pre- 
viously diluted  with  water,  according  to  direc- 
tions on  the  can. 

For  convalescents,  use  the  most  nourishing 
food  that  you  can  obtain,  give  in  small  amounts; 
consult  the  preference  of  the  patient. 

In  all  cases  where  the  patient  has  fever,  give 
water  freely.  If  possible,  add  to  the  water  a 
small  amount  of  lemon  or  lime  juice.  If  not 
obtainable,  use  citric  acid — crystalized  lemon 
juice — which  keeps  for  an  indefinite  period  and 
can  be  obtained  from  any  Alaska  drug  store. 

All  drinks  in  eruptive  fevers  (fevers  accom- 
panied by  skin  rash)  should  be  given  warm,  as 
this  helps  to  bring  out  the  eruption.  In  cases 
of  fever  without  eruption,  use  ice-cold  drinks. 

36 


FOOD  FOR  THE  SICK.  37 

Where  vomiting  occurs,  the  drinks  ought  to  be 
cold  and  given  in  small  amounts. 

For  infant  patients,  follow  the  rule  of  feeding 
which  you  will  find  in  the  section  on  infant 
feeding  (see  p.  38).  In  vomiting  of  children, 
it  is  better  to  depend  on  barley  water  and  meat 
juice  than  on  milk. 

Barley  water  may  be  prepared  as  follows: 
Take  2  ounces  of  barley,  wash  thoroughly,  add 
2  pints  of  water,  and  boil  gently  till  half  the 
liquid  remains;  strain  and  cool,  and  it  is  ready 
for  use.  A  small  amount  of  salt  or  sugar  may 
be  added ;  if  barley  is  not  obtainable,  use  rice  or 
oatmeal  instead. 

Meat  juice  may  be  prepared  as  follows :  Take 
a  piece  of  reindeer  steak,  moose  meat,  or  beef, 
broil  slightly,  and  with  a  lemon  squeezer  extract 
the  juice.  Give  meat  juice  in  small  amounts 
frequently. 

Ptarmigan  broth.  Skin  the  bird  and  cut  into 
small  pieces,  cover  with  cold  water  (slightly 
salted),  and  boil  2  hours.  A  small  amount  of 
rice  may  be  added. 

Fish  soup.  (Very  useful  in  all  diseases  where 
diarrhea  exists.)  Take  2  pounds  of  well-cleaned 
fish,  put  into  a  kettle,  cover  with  2  pints  of  cold 
water,  add  salt,  pepper,  and  a  little  onion;  boil 
for  one  hour,  and  strain  through  cheesecloth. 


CHAPTER  VI. 
INFANT  FEEDING. 


The  mother's  breast  supplies  the  best  article 
of  food  for  newly  born  babies,  as  it  contains  all 
the  necessary  ingredients  in  proper  proportions. 
At  the  same  time,  if  the  mother's  health  is 
impaired  by  tuberculosis  or  other  wasting 
disease,  lactation  becomes  injurious  not  only  to 
the  baby  but  to  the  mother  herself,  as  it  is  a 
great  drain  on  the  system. 

Breast-fed  children  should  be  given  a  small 
amount  of  previously  boiled  water  (1  or  2  tea- 
spoonfuls)  several  times  a  day,  to  assist  assimi- 
lation. 

The  infant  should  be  trained  to  nurse  at  regu- 
lar intervals,  of  from  2  to  3  hours  at  first, 
lengthening  the  intervals  as  the  child  grows 
older.  The  nursing  should  average  about  20 
minutes.  The  baby  may  be  gi^adually  weaned 
when  9  or  10  months  old. 

It  is  unfortunate  for  the  child  if  it  can  not, 
for  any  reason,  be  nursed  by  the  mother,  as  the 
mortality  in  bottle-fed  infants  is  fully  four  times 
as  great  as  in  those  that  are  breastfed. 

38 


INFANT  FEEDING.  39 

Cow's  milk,  or  fresh  reindeer  milk  where  ob- 
tainable, is  the  best  substitute  for  the  mother's 
milk,  provided  that  the  animals  from  which  the 
milk  is  obtained  are  healthy.  The  milk  should 
be  diluted  with  water  in  the  following  propor- 
tions, and  a  small  quantity  of  sugar  and  lime 
water  added: 
For  infants  from — 

1  to  2  months  old — one-fourth  milk,  three- 
fourths  water; 

2  to  4  months  old — one-half  milk,  one-half 
water ; 

4  to  6  months  old — three-foui"ths  milk,  one- 
fourth  water; 

6  to  12  months  old — pure  milk. 

If  the  baby  is  troubled  with  gas,  a  tiny  pinch 
of  baking  soda  may  be  added  from  time  to  time. 

The  feeding  bottle  and  nipple  must  be  scrupu- 
lously clean.  After  each  feeding  the  milk  which 
remains  in  the  bottle  should  be  thrown  away 
and  the  bottle  thoroughly  cleaned  with  hot 
water,  to  which  may  be  added  2  tablespoonfuls 
of  sand. 

The  best  form  of  nipple  is  the  simple  rubber 
nipple,  without  the  glass  tube.  The  nipple 
should  be  kept  in  a  solution  of  Boric  acid  when 
not  in  use.     Do  not  allow  the  bottle  to  stand 


40  MEDICAL  HANDBOOK. 

unwashed  after  feeding,  as  the  milk  attracts 
flies,  which  carry  on  their  legs  germs  of  all 
diseases. 

Next  to  cow's  milk,  the  Eagle  Brand  condensed 
milk  seems  to  be  the  best  food  for  infants  in 
Alaska;  at  least  that  is  the  opinion  of  the  physi- 
cians. It  should  be  diluted  according  to  direc- 
tions on  the  can.  Sometimes  this  may  be  modi- 
fied by  the  addition  of  a  little  malted  milk. 
Always  add  a  little  lime  water  (1  or  2  teaspoon- 
fuls),  as  you  do  to  cow's  milk.  As  condensed 
milk  is  only  a  partial  substitute  for  the  mother's 
milk,  if  used  alone  it  predisposes  to  scrofula, 
rickets,  etc. 

Burdick  advises  the  addition  of  the  flour  ball, 
which  is  prepared  as  follows :  Plain  wheat  flour 
is  boiled  in  a  bag  for  5  hours;  then  dried,  broken 
open,  the  rind  rejected,  and  the  remainder 
grated  to  a  powder.  Take  1  pint  of  milk  and  1 
pint  of  sterile  water  and  a  heaping  tablespoonf ul 
of  boiled  flour,  a  bit  of  cinnajnon  bark  (to  give 
flavor  for  certain  children),  and  a  pinch  of 
conamon  table  salt.  The  milk  is  placed  on  the 
fire  and  heated;  the  flour  is  rubbed  to  a  fine 
paste  with  the  water,  added  to  the  milk,  and 
brought  to  the  boiling  point.  When  taken  from 
the  fire  the  salt  should  be  added,  and  the  prep- 


INFANT  FEEDING.  41 

aration  is  then  ready  to  be  placed  on  ice.  It 
should  be  heated  again  when  used.  Two  ounces 
every  2  hom^s  should  be  given  to  a  child  1  month 
old.  The  quantity  should  be  increased  J  ounce 
every  month,  while  the  water  is  reduced  1  ounce 
every  month. 

Overfeeding  of  infants  should  be  avoided,  but 
at  the  same  time  a  proper  amount  of  nourish- 
ment must  be  given,  as  it  builds  up  the  constitu- 
tion for  after  life.  By  careful  observation  the 
mother  herself  can  usually  decide  the  proper 
amount  of  food.  If  food  of  proper  quality  and 
quantity  is  given  to  an  infant,  there  should  be 
no  vomiting,  no  colic,  no  constipation,  and  no 
undigested  milk  in  the  stools,  and  there  should 
be  a  gradual  increase  in  weight  and  strength. 

In  King's  Manual  of  Obstetrics,  beginning  at 
p.  278,  valuable  information  on  this  subject  may 
be  found. 


CHAPTER  VII. 
HINTS  ON  DOCTORING. 


If  you  are  not  sure  what  disease  your  patient 
has,  treat  the  symptoms,  such  as  cough,  vomit- 
ing, fever,  etc.  Begin  all  treatments  by  causing 
a  thorough  evacuation  of  the  bowels.  Cathartics 
are  beneficial  and  essential  even  in  some  cases  of 
diarrhea.  This  applies  to  the  diarrheas  pro- 
duced by  irritation  of  the  bowels  caused  by 
decomposition  of  undigested  or  contaminated 
foods.  In  cases  of  this  kind  the  administration 
of  a  cathartic  removes  mechanically  the  cause 
of  the  trouble,  and  the  diarrhea  ceases.  Castor 
oil,  or  calomel,  is  the  most  suitable  remedy  for 
this  purpose. 

Always  put  your  fever  patient  to  bed  at  once. 
Do  not  forget  that  all  diseases  having  fever 
accompanied  by  skin  eruption  are  contagious; 
so  quarantine  your  patient  without  delay. 

The  majority  of  sore  throats  are  also  conta- 
gious; therefore  be  careful  to  destroy  the  dis- 
charges from  the  nose  and  throat.  Use  common 
sense  where  your  knowledge  is  not  sufficient, 

42 


HINTS  ON  DOCTORING.  43 

and  do  not  change  your  remedies  too  often.  Be 
cheerful  with  the  sick,  and  do  not  forget  that 
kindness  often  cures,  especially  with  children. 

"  Just  where  sickness  begins  is  a  difficult  mat- 
ter to  decide,  but  one  of  the  most  constant  signs 
of  a  departure  from  the  normal  standard  of 
health  is  fever." — Bryce. 

In  dressing  wounds,  ulcers,  etc.,  cleanliness  is 
of  the  first  importance.  Always  wash  your 
hands  thoroughly  before  touching  an  abraded 
(or  broken)  skin.  Avoid  touching  pus,  as  it  is 
infectious,  and  be  certain  to  wash  your  hands 
after  touching  or  dressing  any  case. 

Be  careful  in  the  use  of  antiseptic  tablets 
containing  mercury,  as  it  is  often  absorbed  by 
the  broken  skin,  and  not  only  salivates  but  may 
cause  death.  Never  use  a  stronger  solution  of 
Bichloride  of  Mercury  than  1  to  1,000.  It  is 
easily  absorbed  by  the  mucous  membrane,  and 
its  use  as  a  vaginal  douche  should  be  avoided. 

Do  not  forget  to  inquire  of  the  patient  whether 
he  passes  urine  regularly;  if  not,  give  sweet 
spirits  of  niter  and  plenty  of  water. 

In  all  cases  of  convulsions,  do  not  wait  to 
ascertain  the  cause,  but  place  the  patient  in  a 
hot  bath.  Be  sure  that  the  water  is  not  so  hot 
as  to  scald  the  patient.     If  a  bath  is  not  obtain- 


44  MEDICAL  HANDBOOK. 

able,  wrap  the  patient  in  sheets  wrung  out  of 
hot  water,  cover  with  blankets,  and  place  hot- 
water  bottles  around  him  to  keep  him  warm. 
Give  to  children  in  convulsions,  besides  the  hot 
bath  or  pack,  2  grains  of  Bromide  of  Potassium. 

As  all  cough  medicines  depend  for  their  action 
on  some  form  of  opium,  which  is  a  habit-forming 
drug,  discontinue  them  as  soon  as  the  cough 
stops.  The  dose  of  the  majority  of  cough 
mixtures  is  a  teaspoonful  for  adults;  to  children 
give  in  proportion. 

Do  not  forget  that  prevention  (as  quarantine 
and  separation  of  patients  who  have  contagious 
or  infectious  diseases)  saves  more  lives  than  any 
quantity  of  drugs. 


CHAPTER   VIII. 
POULTICES  AND  HOT  FOMENTATIONS. 


Poultices  are  widely  used.  They  must  always 
be  applied  as  hot  as  can  be  borne,  care  being 
taken  not  to  scald  the  patient.  Poultices  must 
be  changed  at  least  every  2  or  3  hours,  great 
care  being  taken  not  to  chill  the  exposed  sur- 
face. They  should  be  covered  with  oiled  silk 
or  flannel  to  retain  the  heat. 

Poultices  are  used  to  allay  pain  and  relieve 
inflammation.  If  applied  over  an  inflamed  area 
for  a  long  period,  suppuration  (formation  of  pus) 
may  result. 

Flaxseed  poultice  is  made  as  follows :  Put  into 
a  vessel  the  necessary  amount  of  water,  stir  flax- 
seed meal  into  it  until  of  the  consistency  of  very 
thicjc  cake  batter,  then  spread  smoothly  on  a 
piece  of  muslin  or  cheesecloth,  which  should  be 
large  enough  to  fold  over  the  surface  of  the  poul- 
tice. Apply,  and  cover  with  oiled  silk,  muslin, 
or  rubber  cloth,  and  bandage  firmly  to  keep  in 
proper  position.  If  more  stimulation  is  required, 
add  to  the  flaxseed  poultice  a  small  amount  of 
mustard  (1  or  2  teaspoonfuls  to  a  large  poultice). 

Mustard  paste:  Take  1  part  of  mustard  and 
6  parts  of  flour  and  make  into  a  paste  with  tepid 

45 


46  MEDICAL  HANDBOOK. 

water;  spread  the  mixture  on  a  piece  of  cloth^ 
cover  with  cheesecloth,  and  apply  over  the  seat 
of  pain;  let  it  remain  for  5  or  10  minutes,  taking 
care  not  to  blister  the  skin.  The  skin  of  children 
is  very  tender;  so  be  careful  in  applying  mustard 
plasters  to  infants. 

Turpentine  stupes:  Into  a  gallon  of  boiling 
water  add  1  tablespoonful  of  turpentine,  and 
stir.  Soak  a  piece  of  flannel  of  the  proper  size 
in  this  solution  and  wring  out  the  excess.  Apply 
over  the  seat  of  pain  and  cover  with  towels  or 
rubber  sheeting.     Change  every  10  or  15  minutes. 

Hot  fomentations  are  made  by  dipping  into 
boiling  water  several  layers  of  flannel;  wring  out 
and  apply  quickly;  change  every  10  or  15 
minutes. 

Fomentations  and  stupes  must  be  kept  warm; 
where  it  is  impossible  to  change  them  so  often, 
apply  a  hot- water  bottle  over  them. 

Dry  heat  is  an  excellent  remedy  for  pain,  and 
may  be  applied  by  means  of  hot-water  bottles, 
hot  bricks,  hot  stove  lids,  hot  sand  bags,  and 
hot  plates.  Always  wrap  the  heated  object  in 
a  heavy  flannel  cloth,  several  newspapers,  or 
bath  towels  before  placing  it  on  the  skin.  In 
every  case  where  you  use  hot  applications  test 
the  heat  on  your  cheek  before  applying  to  the 
patient,  in  order  to  prevent  burning  him. 


CHAPTER  IX. 

SYMPTOMS. 


Fever,  or  increase  of  bodily  temperature,  is 
best  explained  as  a  condition  where  the  produc- 
tion of  heat  is  greater  than  its  relative  loss. 
Fever  by  itself  is  merely  a  sympton  of  some 
morbid  process,  and  only  significant  when  com- 
bined with  other  symptoms.  With  every  vol- 
untary or  involuntary  movement  of  the  body, 
with  every  nerve  impulse,  even  with  every 
thought,  there  is  a  certain  amount  of  heat  pro- 
duced and  distributed  throughout  the  body,  to 
be  stored  up  and  used  as  vital  energy. 

In  cold-blooded  animals  the  vital  heat  is  lost 
as  rapidly  as  it  is  produced.  In  warm-blooded 
animals  this  heat  does  not  escape  until  a  certain 
amount  has  accumulated  within  the  system. 
In  the  human  body  the  production  of  heat  bal- 
ances evenly  with  the  loss  of  it,  thus  making 
possible  the  even  accumulation  of  normal  heat 
in  a  healthy  person  to  a  temperature  of  98J° 
F.  As  the  changes  of  the  external  temperature 
vary  not  only  in  the  different  seasons,  but  change 

47 


48  MEDICAL  HANDBOOK. 

constantly,  the  human  body  is  provided  with  a 
delicate  mechanism  which  regulates  the  heat 
production  and  the  heat  elimination.  This  mech- 
anism for  controlling  the  temperature  is  located 
in  the  brain  and  consists  of  nerve  centers  from 
which  messages  are  sent  out,  as  from  a  central 
telephone  office,  to  the  different  organs. 

The  skin,  through  its  pores,  can  not  only 
eliminate  the  excess  of  heat,  in  perspiration, 
etc.,  but  can  also  reverse  the  process,  thus  ren- 
dering the  escape  of  heat  impossible. 

When  this  mechanism  of  heat  production 
becomes  abnormal  the  temperature  of  the  body 
either  rises  or  falls  rapidly.  This  may  be  due 
to  disorder  of  the  nerve  system,  to  sudden  chill- 
ing of  the  body,  or  to  the  entrance  into  the 
system  of  vegetable  bacteria  or  animal  para- 
sites. The  rise  or  fall  of  temperature  can  be 
accurately  determined  only  by  the  use  of  a  clin- 
ical thermometer. 

The  most  prominent  symptoms  of  fever  are 
abnormal  heat  and  feeling  of  general  uneasi- 
ness, dry  skin,  and  sometimes  delirium.  If  the 
fever  is  long-continued,  the  body  wastes.  In 
all  fevers  the  urine  is  scanty  and  high  colored, 
the  tongue  coated,  the  respiration  and  the  pulse 
rapid. 


SYMPTOMS.  49 

The  normal  temperature  of  the  body  in  adults 
is  98 J°  F.;  in  children  99.  A  temperature  of 
100°  F.  indicates  low  fever,  101  to  104°  F.  indi- 
cate severe  fever;  105  to  106°  F.  indicate  great 
danger;  106  to  108°  F.  indicate  impending 
death. 

The  best  method  for  taking  temperature  in 
children  is  by  rectum.  The  bulb  of  the  ther- 
mometer is  annointed  with  vaseline  and  in- 
serted in  the  orifice  for  2  minutes.  Remember 
that  the  temperature  per  rectum  is  1°  higher 
than  that  by  mouth  in  the  same  patient.  Be 
sure  to  shake  the  mercury  in  the  instrument 
below  98  before  using. 

When  taking  the  temperature  by  mouth,  clean 
the  thermometer  thoroughly;  place  the  bulb  of 
the  instrument  under  the  tongue,  and  see  that 
the  patient's  lips  are  firmly  closed.  After  using, 
place  the  thermometer  in  a  weak  solution  of  Bi- 
chloride of  Mercury. 

Subnormal  temperature  (below  98°)  is  ob- 
served in  collapse  from  shock,  from  hemorrhage, 
and  in  cerebral  and  spinal  diseases;  also  in  con- 
valescence after  pneumonia  and  typhoid  fever. 

Treatment:  The  general  lines  of  treatment  in 
all  fevers  call  for  a  cool,  well-ventilated  room, 

77037°— 13 4 


50  MEDICAL.  HANDBOOK. 

cathartics,  liquid  diet,  and  cold  drinks.  The 
patient  should  be  kept  quiet.  High  fever  (over 
102|°)  is  best  controlled  by  sponging  with  cold 
water  twice  a  day.  This  bath  is  given  by  spong- 
ing the  whole  surface  of  the  body  with  cold  water 
for  a  period  of  10  or  15  minutes.  Be  careful  not 
to  expose  the  body  to  drafts  during  the  proce- 
dure. This  treatment  is  absolutely  safe;  it 
lowers  the  temperature,  quiets  the  patient,  and 
gives  great  comfort  and  relief. 

The  Urine. — In  diabetes  and  congestion  of  the 
kidneys  there  is  ^permanent  increase  qf  urine. 
Frequent  and  painful  urination  is  due  to  inflam- 
mation of  the  bladder,  urethra,  or  to  pressure 
on  the  bladder  by  displacement  of  the  uterus 
or  pregnancy.  Diminished  flow  of  urine  results 
from  excessive  secretion,  as  in  free  perspiration 
and  diarrhea,  from  congestion,  from  obstruction 
of  the  heart  or  lungs,  and  from  kidney  and  liver 
diseases. 

Pain  in  the  abdomen  may  be  due  to  peritonitis, 
tape  worms,  appendicitis,  intestinal  obstruction, 
colic,  or  gallstones.  Pain  in  the  stomach  may  be 
due  to  constipation,  dysentery,  cancer,  ulcers, 
dyspepsia,  neuralgia  of  the  stomach,  etc. 

Hemorrhage  of  the  nose  may  occur  in  chronic 
heart,  lung,  or  liver  disease,  scurvy,  infectious 


SYMPTOMS.  51 

fevers,  typhoid  fever,  and  diseases  (or  injuries) 
of  the  nose. 

Respiration. — In  the  healthy  male  adult  the 
respiration  is  about  18  to  20  per  minute.  Rapid 
respiration  is  noted  in  excitement,  inflammatory 
diseases  of  the  lungs,  anaemia,  hysteria,  pleurisy, 
etc. 

Cough. — Dry  cough  without  expectoration  is 
observed  in  the  beginning  of  inflammatory  dis- 
eases of  bronchi  and  lungs  and  in  pleurisy. 
Moist  {or  loose)  cough  occurs  in  bronchitis, 
convalescent  pneumonia,  and  tuberculosis. 
"  Croupy^^  cough  occurs  in  croup,  whooping 
cough,  tuberculosis,  and  hysteria,  and  from  for- 
eign body  lodged  in  the  larynx. 

Treatment  of  cough:  A  careful  regulation  of 
hygiene,  diet,  clothing,  etc.  Brown  Mixture  or 
Elixir  Heroin  and  Terpin  Hydrate.  In  acute 
coughs  hot  foot  baths,  a  mustard  plaster  on  the 
chest,  the  internal  administration  of  hot  drinks, 
and  5  grains  of  Dover's  powder  every  3  hours. 
In  croupy  cough  give  Wine  of  Ipecac,  1  tea- 
spoonful  at  once,  and  repeat  every  15  minutes 
till  vomiting  occurs. 

Sputum. — In  acute  bronchitis  and  in  asthma 
there  is  mucoid  sputum;  watery,  frothy  sputum 
in  last  stage  of  pneumonia;  muco-purulent  spu- 


52  MEDICAL  HANDBOOK. 

turn  in  chronic  bronchitis,  in  convalescent  pneu- 
monia, and  in  tuberculosis;  'purulent  sputum  in 
tuberculosis  with  cavities  and  abscess  of  the 
lung;  prune  juice  sputum  in  gangrene  of  the 
lungs  and  in  cancer  of  the  lungs;  fibrous-shreds 
sputum  in  membranous  croup,  in  bronchitis,  and 
in  diphtheria;  Jetid  sputum  in  advanced  tuber- 
culosis and  abscess  of  the  lungs. 

The  Lips. — The  color  of  the  lips  indicates  the 
condition  of  the  heart  and  blood.  They  are 
always  pale  in  anaemia,  and  blue  in  heart  dis- 
eases. Dryness  of  the  lips  with  formation  of 
crusts  is  observed  in  fevers. 

The  Pulse  in  adults  is  between  65  and  80  per 
minute;  slower  in  old  age.  At  birth  it  is  be- 
tween 130  and  160,  and  gradually  lessens  as  the 
child  grows  older. 

The  Teeth. — Delayed  dentition  may  be  due  to 
feeding  of  condensed  milk  (or  prepared  food), 
rickets,  or  syphilis. 

Gums. — Bleeding  gums  are  often  associated 
with  scurvy,  and  may  result  from  large  or  long- 
continued  doses  of  mercury. 

The  Tongue. —  The  dry  hrown  tongue  is  noted 
in  tj^hoid  fever  and  diabetes.  In  scarlet  fever 
it   resembles    a    ''strawberry."     A    gray-coated 


SYMPTOMS.  53 

tongue  with  oval  bare  spots  is  indicative  of 
gastro-intestinal  catarrh.  Scars  on  the  tongue 
are  often  indicative  of  syphilis  or  epilepsy. 

Foul  breath  is  often  due  to  diseases  of  the 
tonsils,  caries  of  the  teeth,  lung  diseases,  dyspep- 
sia,  etiC. 

The  Appetite. — ^Inordinate  appetite  is  a  symp- 
tom of  dyspepsia,  diabetes,  or  intestinal  worms. 
Loss  of  appetite  is  common  to  many  diseases. 
Craving  for  unnatural  food  is  noted  particularly 
in  insanity  and  pregnancy. 

Hiccough  results  from  a  spasm  of  the  dia- 
phragm, and  is  often  noted  as  a  temporary  condi- 
tion after  eating  or  drinking.  Persistent  hic- 
cough is  sometimes  present  in  extreme  exhaus- 
tion following  acute  or  chronic  diseases.  It  may 
be  reflex  from  stomach,  hepatic,  intestinal,  or 
peritoneal  disease  or  hysteria. 

The  Stools. — Blood  in  the  stools.  Rapidly 
discharged  blood,  as  in  piles  and  fissure,  is 
nearly  normal  in  appearance.  Retained  blood 
imparts  a  black  or  tarry  appearance  to  the  stools. 
Bloody  stools  result  from  inflammation  of  the 
bowels,  chronic  heart  and  liver  disease,  scurvy, 
infectious  fevers,  piles,  and  fistula.  Watery 
stools  are  noted  in  nervous  diarrhea,  wasting 
diseases,  and  corrosive  poisoning.     Green  stools 


54  MEDICAL  HANDBOOK. 

may  result  from  an  excessive  amount  of  bile  and 
are  a  common  symptom  in  intestinal  diseases  of 
children  (cholera  infantum).  Black  stools  may 
follow  intestinal  hemorrhage  and  use  of  charcoal, 
bismuth,  iron  tonic,  etc.  Red  stools  may  be  due 
to  the  administration  of  logwood.  Mucous 
stools  may  be  due  to  intestinal  catarrh.  Fatty 
stools  result  from  undigested  fats  and  the  absence 
of  bile.  In  typhoid  fever  the  stools  resemble  pea 
soup.  Purulent  stools  result  from  ulceration  or 
abscesses  in  abdomen. 

Vomiting  is  often  due  to  diseases  of  the  stom- 
ach, worms,  specific  fevers,  meningitis,  preg- 
nancy, seasickness,  etc.  Watery  vomit  is  noted 
in  nervous  dyspepsia.  Bilious  or  green  vomit 
may  occur  in  diseases  of  the  liver.  Bloody  vomit 
may  be  due  to  obstruction  of  the  circulation,  as 
in  lung  and  liver  diseases,  scurvy,  infectious 
fevers,  ulcers  of  the  stomach  or  cancer  of  the 
stomach.  Purulent  (pus)  vomit  results  from  an 
abscess  in  oesophagus  or  stomach.  Fecal  vomit 
due  to  intestinal  obstruction. 

Tonsillitis  may  be  a  sympton  of  diphtheria, 
scarlatina,  erysipelas,  etc. 

Loss  of  voice  may  be  caused  by  paralysis,  in- 
flanmiation  of  the  larynx,  foreign  bodies,  or  pro- 
longed use  of  the  voice. 


SYMPTOMS,  55 

Difficult  breathing  is  noted  chiefly  in  asthma, 
croup,  abdominal  distention,  tumors,  aneurism, 
pneumonia,  phthisis,  and  heart  diseases.  Breath- 
ing through  the  mouth,  especially  when  sleeping, 
indicates  adenoids,  enlarged  tonsils,  or  obstruc- 
tion in  the  nose;  or  it  may  occur  in  the  beginning 
of  a  cold. 

Convulsions  usually  develop  from  brain  dis- 
eases, injuries,  alcoholism,  infectious  fevers, 
anemia,  syphilis,  hysteria,  strychnine  poisoning 
or  spinal  meningitis.  Reflex  con\ailsions  in 
young  children  from  gastric  irritation,  intestinal 
parasites,  and  teething. 

The  Skin. — In  anemia,  the  skin  is  pale. 
Pallor  may  result  temporarily  from  exposure  to 
extreme  cold,  shock,  or  collapse.  Yellow  skin 
occurs  in  jaundice;  blue  in  cyanosis. 

Enlargement  of  Veins  may  result  from  chronic 
heart,  lung,  or  liver  disease. 

The  nails  may  become  dry,  brittle,  and  dis- 
colored after  inflammation  or  injury  or  from 
skin  affections.  Curving  of  the  nails  is  ob- 
served in  all  wasting  diseases. 

Offensive  Sweating  is  frequently  associated 
with  rheumatism,  Bright's  disease,  blood  poison- 
ing, infection  with  micro-organisms,  and  tuber- 


56  MEDICAL,  HANDBOOK. 

culosis.  Excessive  sweating  may  be  caused  by 
the  use  of  alcohol  and  by  general  debility. 

Ulcers  may  be  due  to  local  congestion,  vari- 
cose veins,  feeble  circulation,  syphilis,  tuber- 
culosis, or  leprosy. 

Bedsores  are  ulcers  produced  by  pressure. 

Worms,  intestinal. — The  only  positive  evi- 
dence of  worms  is  finding  them  in  the  stools. 

Tidal  Wave  Breathing  (Cheyne-Stokes) . — In 
this  type  of  breathing  the  respirations  gradually 
increase  in  rapidity  until  they  reach  a  climax, 
then  gradually  subside  and  finally  cease  entirely 
for  5  to  50  seconds,  when  they  begin  again.  It 
is  usually  a  forerunner  of  death,  but  cases  have 
been  reported  in  which  it  has  lasted  several 
months. 

The  Pupils  of  the  Eyes  are  contracted  in 
opium  poisoning,  old  age,  anemia,  alcoholism, 
and  diseases  of  the  nervous  system.  Dilatation 
of  the  pupils  is  observed  in  paralysis,  collapse, 
severe  pain,  epilepsy,  and  belladonna  and  cocaine 
poisoning. 

Noises  in  the  Ears  are  observed  in  anemia,  in 
diseases  of  the  ear  or  heart,  and  after  the  use  of 
certain  drugs,  as  quinine  and  salicylic  acid. 

Deafness  is  generally  caused  by  disease  of 
the  ear  itself,  adenoids,  or  diseased  tonsils. 


SYMPTOMS.  57 

Delirimn  may  be  observed  in  pneumonia, 
typhoid  fever,  anemia,  alcoholism,  and  hunger. 

Crying. — Incessant  crying  of  a  baby  is  usually 
due  to  hunger,  earache,  colic,  pain  from  an 
opened  safety  pin,  or  soiled  napkins,  which  cause 
irritation.  Nasal  tone  crying  of  a  baby  is  due 
to  swelling  of  the  mucous  membrane  of  the 
nose  or  to  throat  affections.  Crying  during  an 
attack  of  coughing  is  an  indication  of  some  painful 
affection  of  the  chest.  Hoarse  cry  of  a  baby 
points  to  catarrh  of  the  larynx  or  to  syphilis. 
Whispering  cry  is  a  precursor  of  membranous 
croup. 


CHAPTER  X. 

ERUPTIVE  FEVERS. 


Measles. — Incubation:  10  to  14  days.  Day 
of  rash :  Fourth  day  of  fever.  Character  of  rash : 
It  appears  first  on  the  forehead  and  temples,  in 
raised  blotchy  areas;  these  later  run  together. 
Duration  of  rash:  8  to  12  days. 

Quarantine:  21  days. 

Scarlet  Fever. — Incubation:  1  to  6  days. 
Day  of  rash :  Second  day  of  fever.  Character  of 
rash:  Diffused  red  (like  boiled  lobster),  studded 
with  minute  scarlet  dots.  Duration:  10  to  12 
days. 

Quarantine:  5  weeks. 

Chicken  Pox. — Incubation:  4  days.  Charac- 
ter of  rash :  Raised  small  elevations,  which  later 
become  blisters.  Day  of  rash:  Second  day  of 
fever.     Duration  of  rash:  8  to  10  days. 

Quarantine :  Until  rash  disappears. 

Erysipelas. — Incubation:  4  to  6  days.  Day 
of  appearance  of  swelling:  Second  day.  Charac- 
ter of  swelling:  An  elevated  red  spot  usually  ap- 

58 


ERUPTIVE  FEVERS.  59 

pears  on  the  side  of  the  nose  and  rapidly  spreads 
over  the  forehead  and  face.  Duration  of  swell- 
ing: 7  to  21  days  (relapses  are  common). 

Quarantine  until  swelling  disappears. 

Smallpox. — Incubation:  10  to  14  days.  Day 
of  rash:  Third  day  of  fever.  Character  of  rash: 
It  first  appears  on  the  face  and  wrists  as  small 
round,  red,  hard  pimples  like  shot  beneath  the 
skin,  which  change  into  blisters  and  pustules. 
Duration  of  rash:  22  days. 

Quarantine  until  the  skin  is  entirely  clear. 


CHAPTER  XI. 
PRACTICE  OF  MEDICINE. 


ABORTION. 


The  term  abortion  is  applied  to  the  premature 
termination  of  pregnancy  when  it  occurs  during 
the  first  three  months  of  gestation.  From  the 
fourth  to  the  sixth  month  it  is  called  miscarriage. 
When  occurring  from  the  seventh  month  to  the 
normal  term,  it  is  denominated  premature  de- 
livery. 

The  causes  of  abortion  may  be  physical  weak- 
ness, syphiHs,  tuberculosis,  or  general  diseases, 
as  typhoid  fever,  pneumonia,  or  malaria,  some- 
times sexual  excesses,  physical  or  moral  shock, 
overexertion,  blows  on  the  abdomen,  or  diseases 
of  the  womb. 

Symptoms  of  abortion:  Cramp-like  pains  in  the 
back  and  abdomen;  hemorrhage  from  the  womb. 

Treatment:  Absolute  rest  in  bed;  Morphine 
Sulphate,  J  grain;  to  be  repeated  if  necessary; 
Fluid  Extract  of  Viburnum,  1  teaspoonful  every 
3  hours.  Since  the  greatest  danger  in  abortion 
is  from  blood  poisoning  and  retained  mem- 
branes, surgical  care  is  necessary. 

60 


PRACTICE  OF  MEDICINE,  61 

ABSCESS. 

An  abscess  is  the  result  of  an  inflammatory 
process  due  to  infection  with  pus-producing 
bacteria,  usually  through  some  injury  or  abra- 
sion of  the  skin  or  mucous  membrane. 

Symptoms:  Pain  due  to  compression  of  the 
nerves  and  tissues;  redness,  due  to  distention  of 
the  blood  vessels;  heat,  and  throbbing  from  in- 
creased blood  supply;  fever,  from  general  in- 
fection; fluctuation,  when  pus  is  formed. 

Treatment:  If  the  case  is  seen  early,  an  at- 
tempt may  be  made  to  prevent  the  formation 
of  pus  by  painting  the  inflamed  area  with 
Tincture  of  Iodine  twice  a  day.  Local  applica- 
tions of  hot  compresses  are  very  effective  for 
relieving  pain. 

As  soon  as  the  presence  of  pus  has  been  de- 
termined, the  abscess  should  be  freely  opened 
and  the  cavity  thoroughly  emptied  and  washed 
with  Boric  acid  solution  (2  teaspoonfuls  to  a 
quart  of  hot  water) .  It  should  then  be  covered 
with  Iodoform  gauze,  and  a  surgical  dressing 
applied. 

ADENOIDS. 

Adenoids  are  tumor-like  growths  located  be- 
hind the  soft  palate,  which  interfere  with  proper 
nasal  respiration  and  retard  the  mental  develop- 
ment of  the  child.     They  are  rarely  found  in 


62  MEDICAL  HANDBOOK. 

adults.  Persons  suffering  from  them  should 
have  prompt  attention. 

Symptoms:  Mouth  breathing  and  snoring,  es- 
pecially during  sleep;  deformity  of  the  upper 
jaw;  nasal  discharge;  periodic  deafness  and  pain 
in  the  ears.  The  child  is  subject  to  colds,  ap- 
pears listless,  and  has  a  dull  facial  expression. 
Pupils  with  adenoids  are  slow  and  backward  in 
their  studies. 

Treatment:  Refer  to  physician  for  operation, 
as  removal  is  the  only  cure. 

ANEMIA. 

Anemia  is  a  condition  of  the  blood  in  which 
there  is  a  deficiency  of  red  blood  corpuscles.  It 
may  be  present  in  many  diseases  and  conditions » 

Symptoms:  Unnatural  pallor  of  the  skin  (yel- 
lowish green),  loss  of  strength,  shortness  of 
breath,  headache,  nervousness,  coldness  of  the 
extremities,  heart  palpitation. 

Treatment:  Fresh  air,  good  nourishing  food; 
keep  bowels  open.  Elixir  iron,  quinine,  and 
strychnine,  1  teaspoonful  3  times  a  day,  before 
meals. 

APPENDICITIS. 

May  occur  at  any  age  and  is  usually  due  to 
errors  of  diet,  constipation,  injuries,  typhoid 
fever,  tuberculosis,  or  microbic  infection. 


PRACTICE  OF  MEDICINE.  63 

Symptoms:  Sudden  intense  pain  midway  be- 
tween the  hip  joint  and  the  navel  on  the  right 
side,  with  rigidity  of  the  abdominal  muscles  on 
that  side.  The  patient  lies  on  the  back  with  the 
right  thigh  flexed  on  the  abdomen;  the  tempera- 
ture is  slightly  elevated  and  pulse  rapid. 

Treatment:  Absolute  rest  in  bed;  Epsom  salts, 
1  teaspoonful  in  half  a  glass  of  water,  should  be 
administered  at  once,  and  repeated  if  necessary; 
cold  applications  over  the  seat  of  pain;  when  the 
pain  is  very  severe  it  is  often  necessary  to  use 
Morphine  Sulphate,  J  of  a  grain  by  mouth. 
Always  call  a  physician  if  possible. 

ASTHMA. 

Asthma  is  often  associated  with  other  dis- 
eases of  the  chest  and  respiratory  tract. 

Symptoms:  Shortness  of  breath  (due  to  spasm 
of  the  bronchial  tubes);  intense  desire  for  air, 
with  loud  bronchial  wheezing;  abnormal  expan- 
sion of  the  chest,  caused  by  inability  to  expel 
the  air;    feeling  of  suffocation. 

In  a  few  hours  the  bronchial  tubes  are  usually 
relieved  from  the  accumulated  secretion  (which 
is  coughed  up  and  has  the  appearance  of  gela- 
tin). These  attacks  will  often  occur  without 
any  apparent  cause. 


64  MEDICAL  HANDBOOK. 

Treatment:  Asthma  can  be  greatly  relieved 
by  change  of  climate.  The  attack  will  be  short- 
ened and  relieved  by  the  internal  administration 
of  Codeine  J  grain  and  Potassium  Bromide  15 
grains  (in  water).  This  treatment  may  be  re- 
.  pea  ted  every  half  hour  till  relief  is  obtained. 

BACKACHE. 

Backache  is  not  a  disease,  but  a  symptom 
which  occurs  in  many  forms  of  disease,  both 
acute  and  chronic.  It  is  a  prominent  symptom 
in  malaria,  influenza,  smallpox,  movable  kidneys, 
lumbago,  womb  trouble,  and  all  infectious  dis- 
eases. The  laity  wrongly  attribute  backache 
almost  entirely  to  kidney  trouble.  For  treat- 
ment see  chapter  on  rheumatism,  which  de- 
scribes lumbago. 

BED  SORES. 

Bed  sores  are  local  ulcers  of  the  skin,  and  occur 
in  persons  who  are  compelled  by  illness  or  injury 
to  remain  in  one  position  in  bed  for  a  long  time. 

Treatment:  Frequent  change  of  position  and 
cleanliness  will  usually  prevent  the  formation  of 
bed  sores.  The  skin  should  be  hardened  by 
bathing  with  alcohol.  After  bathing,  the  part 
should  be  carefully  dried  and  dusted  with  Tal- 
cum powder  or  starch. 


PRACTICE  or  MEDICINE.  65 

BLOOD  POISONING. 

Blood  poisoning  is  caused  by  different  germs, 
or  may  be  produced  by  absorption  of  poison 
from  decomposed  animal  matter.  The  germs 
may  gain  access  to  the  blood  through  the  womb 
after  childbirth  or  abortion,  through  wounds, 
sores,  and  abrasions  of  the  mucous  membranes 
or  skin. 

Symptoms:  Sharp  rise  of  temperature,  rapid 
pulse,  nausea  and  frequent  vomiting,  profuse 
offensive  sweating.  Death  frequently  takes  place 
within  a  few  days. 

Treatment:  Cleanse  the  wound  thoroughly. 
Give  quinine,  3  grains  every  3  hours,  and  a 
tablet  of  Strychnine,  gV  grain,  3  times,  a  day.  If 
there  is  diarrhea,  give  Tincture  opium  cam- 
phorated (paregoric)  5  to  10  drops,  with  Bis- 
muth Subnitrate,  15  grains,  every  3  or  4  hours. 
If  there  is  constipation,  2  teaspoonfuls  of  Epsom 
salts  in  half  glass  of  water  3  times  a  day.  For 
fever,  cold  sponging.  Milk  diet.  If  blood  poi- 
soning is  due  to  childbirth  or  abortion,  in  addi- 
tion to  the  treatment  given  above  use  vaginal 
douches  with  Vaginal  Antiseptic  Tablets. 


66  MEDICAL  HANDBOOK. 

BRONCHITIS. 

Bronchitis  is  commonly  called  '^cold  on  the 
chest."  It  is  sometimes  associated  with  measles 
and  whooping  cough. 

Symptoms:  It  frequently  begins  with  sneezing, 
as  ''a  cold  in  the  head,"  or  with  slight  chills, 
which  are  followed  by  fever.  Patient  complains 
of  a  pain  in  the  chest  which  is  increased  by  the 
act  of  coughing.  The  cough  is  at  first  dry,  but 
within  a  day  or  two  it  becomes  loose,  and  there 
is  abundant  expectoration. 

Treatment:  Give  1  teaspoonful  of  Aromatic 
Cascara  Sagrada  to  move  the  bowels.  Put 
patient  to  bed  in  a  warm,  well-ventilated  room. 
Allow  liquid  diet  only.  Perspiration  should  be 
promoted  by  a  hot  foot  bath,  hot  drinks,  and 
5  grains  of  Dover's  powder. 

If  fever  is  high,  3  grains  of  quinine  may  be 
given  every  3  hours. 

Should  cough  become  troublesome  give  Brown 
Mixture,  1  teaspoonful  every  2  or  3  hours. 
During  convalesence  give  Elixir  iron,  quinine, 
and  strychnine,  1  teaspoonful  3  times  a  day. 

BOILS. 

A  boil  is  a  hard  red  swelling  of  microbic  origin, 
which  generally  ends  in  suppuration. 


PEACTICE  OF  MEDICINE.  67 

Treatment:  Apply  locally  Tincture  of  Iodine 
and  hot  flaxseed  poultices.  If  pus  is  present, 
an  incision  is  necessary,  followed  by  a  thorough 
cleansing  with  Hydrogen  Peroxide.  To  pre- 
vent infection  of  the  surrounding  parts,  wash 
carefully  with  a  solution  of  Bichloride  of  Mer- 
cury 1  to  4,000. 

BURNS  AND  SCALDS. 

Burns  are  produced  by  dry  heat;  scalds  by 
steam,  hot  liquid,  or  strong  acids.  The  appear- 
ance is  the  same  from  either  cause.  Burns  may 
be  classified  as  follows:  Slight  or  superficial 
burns;  mild,  when  the  upper  layer  of  a  small 
area  of  the  skin  is  destroyed;  severe,  when  all 
the  layers  of  the  skin  (of  a  large  area)  are  de- 
stroyed; grave,  when  the  burn  extends  into  the 
muscles  and  exposes  the  bone;  and  fatal,  when 
the  skin  of  one-fourth,  or  more,  of  the  entire 
body  is  destroyed. 

Symptoms:  Pain  in  varying  degrees  according 
to  the  severity  of  the  burn;  swelling,  ulceration, 
and  sloughing. 

Treatment:  Severe  pain  in  grave  or  very  ex- 
tensive burns  demands  the  use  of  Morphine,  J 
of  a  grain ;  for  children  substitute  for  this  Dover's 
powder,  2  or  3  grains  (or  Camphorated  tincture 
opium,  according  to  age) .     To  prevent  collapse, 


68  MEDICAL  HANDBOOK. 

place  the  patient  in  bed  at  once  and  surround 
him  with  hot-water  bottles.  Cover  with 
blankets  and  give  Aromatic  spirits  of  ammonia , 
half  a  teaspoonf ul  in  water  at  once ;  repeat  every 
hour  or  two.  Regulate  the  bowels  by  giving 
Epsom  salts  or  Compound  cathartic  pills. 

Local  treatment:  Bicarbonate  of  Soda  (baking 
soda),  made  into  a  thick  paste,  should  be  applied 
to  the  burned  or  scalded  area  with  clean  gauze 
or  cotton.  The  exclusion  of  air  from  the  burn 
is  important,  to  reduce  pain  and  prevent  infec- 
tion. After  the  pain  subsides,  wash  with  a 
weak  solution  of  Hydrogen  Peroxide,  and  apply 
Ichthyol  ointment  by  spreading  on  gauze  and 
wrapping  around  the  injured  parts;  cover  with 
cotton  and  keep  in  place  by  bandaging.  If  the 
burns  are  not  kept  scrupulously  clean,  erysipelas 
or  blood  poisoning  may  follow. 

Burns  from  carbolic  acid  may  be  speedily 
relieved  by  immediate  washing  with  pure  grain 
alcohol.  For  burns  of  the  mouth  or  throat, 
caused  by  swallowing  hot  fluids  or  strong  chemi- 
cals, use  oil  or  the  white  of  eggs. 

CATARRH  OF  THE  BLADDER. 

Inflammation  of  the  bladder  is  characterized 
by  uneasiness  and  a  sense  of  pain  over  the 
bladder,  with  a  constant  desire  to  urinate.     The 


PRACTICE  OF  MEDICINE. 


urine  is  passed  in  small  quantities,  and  there  is 
continual  pain  and  a  sensation  of  burning  in  the 
urinary  organs.  There  is  a  considerable  amount 
of  mucous  mixed  with  the  urine,  and  in  some 
cases  pus  or  blood. 

Treatment:  Put  patient  in  bed.  In  acute 
cases  it  will  be  of  great  service  to  give  warm 
hip  baths  and  use  poultices  or  a  hot-water  bag 
over  the  bladder.  The  urine  should  be  rendered 
bland  by  the  administration  of  a  teaspoonful  of 
Bicarbonate  of  Soda  in  a  half  glass  of  water 
every  2  or  3  hours,  and  the  quantity  increased 
by  giving  large  amounts  of  water.  For  constant 
desire  to  urinate  use  Potassium  Bromide,  15 
grains,  with  Tincture  opium  camphorated,  10 
drops  in  water,  every  3  hours.  Give  Salol,  10 
grains  every  4  hours,  until  urine  is  clean.  Chronic 
cases  should  be  referred  to  a  physician. 

CHICKEN  POX. 

Is  an  acute  contagious  disease  of  short  dura- 
tion (about  a  week). 

Symptoms:  Slight  fever,  with  appearance  of 
eruption;  this  eruption  resembles  small  blisters, 
is  scattered  over  the  entire  body,  and  appears 
in  daily  crops.  There  is  itching  and  burning  of 
the  skin. 


70  MEDICAL  HANDBOOK. 

Treatment:  Rest  in  bed;  light  diet;  applica- 
tion of  carbolized  vaseline  to  allay  itching  and 
prevent  scratching  and  moderate  administration 
of  castor  oil  is  all  that  will  be  necessary  in  the 
majority  of  cases.     Isolate  the  patient. 

CHILBLAINS  AND  FROSTBITES. 

Symptoms  of  chilblain  are  too  well  known  in 
Alaska  to  need  special  description.  The  treat- 
ment is  simple,  as  a  few  applications  of  Tincture 
Iodine  speedily  effect  a  cure,  providing  they  are 
used  in  time  and  the  parts  have  not  yet  ulcerated. 
Ulcerated  chilblains  should  be  dusted  with  Boric 
acid  or  Bismuth  Subnitrate  and  dressed  like  any 
other  wound. 

Symptoms  of  frostbite:  The  frostbitten  part 
becomes  white  and  painful.  The  color  of  the 
skin  changes  later  to  dark  red  or  purple,  and  it 
is  sometimes  covered  with  blisters  which  rapidly 
change  to  ulcerations.  The  frozen  part  becomes 
numb. 

Treatment:  The  first  steps  are  important;  the 
patient  must  not  be  allowed  to  enter  a  heated 
room.  A  stimulant,  as  Aromatic  spirits  am- 
monia, 1  teaspoonful  in  haK  a  glass  of  water, 
should  be  given  at  once,  the  patient  carried  to 
an  unheated  shelter,   the  frozen  parts  gently 


PRACTICE  OF  MEDICINE.  71 

rubbed;  the  patient  should  be  warmly  covered. 
As  frostbite  may  occur  in  different  parts  of  the 
body,  the  whole  body  must  be  carefully  exam- 
ined. After  this,  hot  coffee,  milk,  or  tea  should 
be  administered.  If  the  sensation  of  cold  has 
left  the  patient,  remove  him  to  a  moderately 
warm  room  (not  too  warm),  dust  the  frostbitten 
parts  with  powdered  Bismuth  Subnitrate  or 
Boric  acid,  and  cover  with  layers  of  wool  or 
absorbent  cotton.  Be  sure  that  the  frostbitten 
part  is  entirely  dry  before  applying  any  powder, 
as  moist  gangrene  might  result,  with  great  loss 
of  tissue  or  death.  It  requires  a  surgeon  to 
decide  when  to  operate. 

CHOLERA  INFANTUM. 

A  disease  of  young  children,  caused  by  micro- 
organisms taken  into  the  stomach  with  food.  It 
is  extremely  dangerous. 

Symptoms:  Vomiting,  diarrhea,  high  fever; 
the  discharges  from  the  bowels  are  watery  and 
greenish  in  color,  with  offensive  odor.  The 
irritability  of  the  stomach  causes  food  to  be 
rejected.  The  strength  is  rapidly  lost  and  the 
baby  cries  from  pain  in  the  bowels,  and  often 
passes  into  a  half-unconscious  state,  from  which 
it  may  never  recover. 


72  MEDICAL  HANDBOOK, 

Treatment:  Begin  treatment  by  giving  1  tea- 
spoonful  of  castor  oil,  and  repeat  if  necessary. 
This  is  for  the  purpose  of  expelling  the  infected 
or  fermented  food  from  the  bowels.  Restrict 
the  diet  for  24  hours;  give  plenty  of  water  and 
use  hot  applications  over  the  abdomen.  If  the 
fever  is  high,  sponge  the  child  with  alcohol  and 
water.  For  vomiting,  Bismuth  Subniti'ate,  5 
grains  every  2  hours,  and  Tinctura  opii  cam- 
phorata  (paregoric)  3  drops  in  water  every  3  or 
4  hours. 

COLIC,  INFANTILE. 

In  most  cases  is  caused  by  indigestion,  over- 
loading the  stomach,  or  unsuitable  food.  It 
occurs  mostly  in  bottle-fed  infants. 

Symptoms:  The  abdomen  is  distended  and 
hard;  the  baby  cries  sharply  and  suddenly, 
drawing  up  its  knees  toward  the  abdomen;  the 
hands  and  feet  are  cold;  there  is  pain  in  the 
region  of  the  navel;  vomiting  is  very  frequent 
and  always  violent. 

Treatment:  Warm  the  extremities  of  the  child 
with  a  hot-water  bag.  Gentle  rubbing  of  the 
abdomen  is  often  beneficial.  Give  a  few  drops 
of  Aromatic  spirits  of  ammonia  internally,  and 
follow  this  at  once  with  an  enema  of  a  few 
ounces  of  warm  water.     A  little  weak  sweetened 


PEACTICE  or  MEDICINE.  73 

peppermint  water,  with  a  tiny  pinch  of  baking 
soda,  reUeves  some  cases. 

CONSTIPATION  AND  CATHARTICS. 

Constipation  may  be  acute  or  chronic. 

Treatment:  Cathartics  and  laxatives  should 
be  avoided,  as  they  eventually  produce  intestinal 
paralysis.  The  patient  should  add  to  his  diet 
fresh  or  cooked  fruit;  prunes  are  especially 
useful.  It  is  important  that  a  regular  hour  each 
day  should  be  selected  for  evacuating  the  bowels. 
For  chronic  constipation  give  1  or  2  Cascara 
Compound  Pills,  or  Fluid  Extract  Cascara,  1 
teaspoonful  at  bedtime.  Castor  oil  is  the  best 
laxative  for  children.  Epsom  salts  should  be 
given  to  adults  in  doses  of  1  or  2  tablespoohfuls 
dissolved  in  water  1  hour  before  breakfast.  This 
flushes  the  bowels  and  produces  watery  stools. 

Compound  cathartic  pills  are  best  taken  at 
night.  Dose,  1  or  2  to  adults.  Do  not  use  them 
in  chronic  constipation. 

Calomel  is  of  special  value  in  the  constipation 
of  biliousness,  accompanied  by  loss  of  appetite, 
heavily  coated  tongue,  and  a  bad  taste  in  the 
mouth.  To  adults  give  -J  grain  every  hour  for 
4  doses;  then  follow  with  2  tablespoonfuls  of 
Epsom  salts.     Repeat  if  necessary. 


74  MEDICAL  HANDBOOK. 

CONVULSIONS,  INFANTILE. 

Occur  in  nervous  and  poorly  nourished  chil- 
dren. They  are  an  initial  symptom  in  many 
diseases.  The  most  common  cause  is  an  im- 
proper quantity  or  quality  of  food,  or  teething. 

Symptoms:  Twitching  of  the  muscles  of  the 
face,  hands,  and  feet.  The  teeth  are  gnashed 
together,  and  there  is  frothing  at  the  mouth. 
The  child  often  becomes  unconscious. 

Treatment:  Hot  bath;  apply  cold-water  com- 
press to  the  head,  and  weak  mustard  plaster  to 
the  back  of  the  neck.  Give  Potassium  Bromide, 
2  grains,  in  a  teaspoonful  of  water  every  hour  for 
2  or  3  hours.  An  enema  of  warm  water  should 
precede  the  introduction  of  drugs.  If  convul- 
sions are  due  to  teething,  lance  the  gums  over 
the  inflamed  area  with  a  surgical  knife  which  has 
previously  been  well  disinfected. 

CROUP,  SPASMODIC. 

Occurs  in  children  of  from  2  to  5  years  of  age. 
Enlarged  tonsils  and  adenoids,  taking  cold,  or 
overeating  just  before  retiring  are  predisposing 
causes. 

Symptoms:  Difficult  breathing,  "croupy" 
cough,  shortness  of  breath,  and,  in  bad  attacks, 
paroxysms  of  suffocation. 


PRACTICE  or  MEDICINE.  75 

Treatme7it:  Hot  poultices  applied  to  the  throat 
serve  to  relieve  the  spasm.  Give  1  teaspoonfui 
of  Wine  of  Ipecac  (or  Sirup  of  Ipecac)  every  5 
minutes  until  vomiting  occurs.  After  vomiting 
empty  the  bowels  with  an  enema  and  give  Po- 
tassium Bromide,  3  grains  every  3  or  4  hours. 
Repeat  this  treatment  if  the  attack  recurs. 

CORYZA  (COLD  IN  THE  HEAD). 

Coryza  occurs  frequently  in  this  country, 
especially  near  the  coast,  where  it  is  moist  and 
the  temperature  is  more  variable.  It  usually 
follows  exposure  to  cold,  particularly  if  the  feet 
have  been  damp.  It  may  also  occur  as  the  fore- 
runner of  measles,  whooping  cough,  scarlet  fever, 
or  influenza. 

Symptoms:  It  begins  with  an  attack  of  sneez- 
ing and  feeling  of  stuffiness  in  the  head,  accom- 
panied by  inability  to  breathe  through  the  nose. 
In  a  few  hours  there  is  a  profuse  watery  discharge 
from  the  nose,  which  becomes  inflamed  and  pain- 
ful. There  is  frontal  headache,  with  a  loss  of 
sense  of  smell  and  taste;  slight  fever.  All  these 
symptoms  may  become  more  severe,  if  the  cold 
persists  for  a  length  of  time^  temporarily  affect- 
ing the  hearing  and  irritating  the  throat  from 
constant  mouth  breathing.     In  a  week  or  so  the 


76  MEDICAL,  HANDBOOK. 

nasal  discharge  becomes  purulent,  and  the  upper 
lip  may  become  badly  swollen.  The  duration  of 
a  common  cold  is  usually  from  1  day  to  3  weeks. 
Treatment:  The  most  successful  treatment  is 
a  hot  mustard  foot  bath  (a  tablespoonful  of 
mustard  to  a  bucket  of  hot  water),  followed  by 
10  grains  of  Dover's  powder  and  copious  hot 
drinks  (hot  lemonade  or  tea) .  Place  the  patient 
in  a  warm  bed  and  cover  with  blankets,  so  as  to 
induce  profuse  perspiration.  Give  a  good  ca- 
thartic. On  the  next  day,  if  cold  still  persists, 
give  a  Salol  and  Phenacetin  pill  every  3  hours. 
This  may  be  combined  with  Dover's  powder,  2 
grains.  Applications  of  vaseline  in  and  around 
the  nose  and  mouth  are  soothing  and  beneficial. 

DIARRHEA. 

Diarrhea  is  a  symptom  of  some  aonormal  con- 
dition of  the  intestinal  tract. 

Causes:  Impure  food  and  water;  overeating; 
exposure  of  the  abdomen  to  cold.  Chronic 
diarrhea  is  usually  due  to  tuberculosis  of  the 
intestines. 

Symptoms:  Colicky  pains,  constant  strain- 
ing and  desire  to  empty  the  bowels.  The 
stools  may  be  offensive  and  contain  blood. 
General  weakness. 


PRACTICE  OF  MEDICINE.  77 

Treatment:  To  children  give  1  teaspoonful 
castor  oil,  to  unload  the  bowels  of  the  offending 
mass.  Repeat  the  dose  in  4  hours  if  necessary, 
then  follow  with  5  grains  of  Bismuth  Subnitrate, 
combined  with  Camphorated  tincture  opium 
(paregoric),  3  drops  every  3  or  4  hours  till  the 
diarrhea  ceases.  No  food  must  be  given  for  at 
least  12  hours,  after  which  liquid  diet  in  modera- 
tion may  be  allowed. 

For  adults,  follow  general  treatment  as  above, 
substituting  calomel,  1  grain,  for  the  castor 
oil;  4  hours  later  Epsom  salts,  2  tablespoonfuls, 
should  be  administered. 

The  best  remedy  for  checking  diarrhea  is 
Zinc  Sulphocarbolate  given  in  doses  of  1  grain 
every  2  or  3  hours.  In  cases  of  continued 
bloody  stools,  give  1  Lead  and  Opium  pill  every 
4  hours  for  2  doses. 

In  cases  of  great  weakness  1  teaspoonful  of 
Elixir  iron,  quinine,  and  strychnine  3  times  a 
day. 

DIPHTHERIA. 

Diphtheria  is  a  highly  contagious  disease, 
usually  of  childhood.  Any  suspected  case  should 
be  immediately  isolated  and  a  physician  called 
if  possible. 


78  MEDICAL  HANDBOOK. 

Symptoms:  More  or  less  fever,  with  spreading 
inflammation  of  the  mucous  membrane  of  the 
throat  and  tonsils;  formation  of  greenish  white, 
slightly  elevated  membrane  over  the  tonsils; 
sv/elling  of  the  neck  glands.  The  child  may  not 
appear  very  sick. 

Treatment:  Sustain  the  child  from  the  start 
with  quinine,  1  grain,  every  3  hours,  and  Tinc- 
ture of  Iron,  5  drops  in  water.  A  simple  gargle 
of  Hydrogen  Peroxide  will  answer  all  purposes 
for  local  medication.  Watch  the  pulse  and 
give  strychnine  tw  oi  a  grain  every  3  hours  if  it 
shows  a  disposition  to  fail.  Always  keep  the 
patient  in  bed.  After  convalescence  the  child 
should  be  well  clad,  and  a  tonic  of  Elixir  iron, 
quinine,  and  strychnine  given  for  a  long  time, 
as  there  may  be  paralysis,  or  sudden  heart 
failure,  long  after  all  danger  seems  past. 

All  sputum  and  nasal  discharges  should  be 
collected  and  burned.  Dishes,  spoons,  etc., 
should  be  thoroughly  sterilized  by  boiling  for 
one-half  hour  before  being  taken  out  of  the 
sick  room.  Remember  that  the  only  radical 
treatment  is  the  administration  of  Antitoxin. 

DYSPEPSIA. 

Poor  digestion  is  a  symptom  which  accom- 
panies every  disease  of  the  stomach. 


PRACTICE  OF  MEDICINE,  79 

Symptoms:  Coated  tongue,  heartburn,  head- 
ache, sense  of  fullness  and  distress  over  the 
stomach  after  eating. 

Treatment:  Regulate  the  diet  by  decreasing 
fatty  and  starchy  foods  and  increasing  lean 
meats,  reindeer  steak,  game,  and  fish.  Regu- 
late the  bowels.  Give  Bicarbonate  of  Soda  1 
teaspoonful  in  J  glass  of  water  after  meals,  or 
half  a  teaspoonful  of  Aromatic  spirits  of  anmionia 
in  half  a  glass  of  water. 

DOG  OR  OTHER  ANIMAL  BITES. 

Dog  bites  are  of  frequent  occurrence  in  Alaska. 
There  is  more  danger  of  blood  poisoning  than  of 
the  much-dreaded  hydrophobia,  as  there  are  no 
cases  of  the  latter  disease  on  record  in  Alaska. 
The  bite  of  any  animal  may  result  in  blood 
poisoning,  which  is  due  to  the  decomposed  se- 
cretion from  the  mouth,  to  the  unhealthy  condi- 
tion of  the  animal,  which  may  be  suffering  from 
some  disease,  or  to  decomposed  food  adhering  to 
the  teeth.  All  wounds  produced  by  bites  (even 
human)  should  be  promptly  attended  to. 

Treatment:  Enlarge  the  wound  if  necessary, 
to  produce  a  free  flow  of  blood.  Cleanse  thor- 
oughly with  pute  Hydrogen  Peroxide  or  carbolic- 
acid  solution  (1  teaspoonful  to  1  pint  of  warm 
water).     Dress  with  clean  gauze  and  bandage. 


80  MEDICAL  HANDBOOK. 

DISEASES  OF  THE  EYE. 

It  is  important  that  all  inflammations  of  the 
eye  be  treated  in  the  early  stages,  otherwise 
blindness  or  impaired  vision  may  follow.  For 
treating  inflammations  of  the  eyes  prepare  two 
solutions  as  follows:  Into  a  4-ounce  bottle  put 
1  teaspoonful  of  Boric  acid  and  fill  the  bottle 
with  boiling  water;  then  shake  well  till  dissolved. 
Prepare  the  second  solution  as  follows:  Into  a 
1-ounce  bottle  put  J  teaspoonful  of  Argyrol  and 
fill  it  with  water.  As  Argyrol  stains  fabrics,  be 
careful  not  to  drop  any  on  the  patient's  clothing, 
and  wipe  the  excess  from  the  eyelids  with  clean 
cotton.  A  solution  of  Bichloride  of  Mercury 
will,  however,  remove  Argyrol  stains  from  cloth- 
ing. Argyrol  is  a  very  expensive  drug;  therefore 
be  careful  in  its  use  and  do  not  dispense  to  pa- 
tients. For  home  treatment  give  them  Boric 
acid  solution. 

SIMPLE    CONJUNCTIVITIS. 

Inflammation  of  the  eye  (pink  eye)  may  be 
caused  by  foreign  bodies,  dust,  exposure  to 
bright  sunlight,  snow  blindness,  measles,  or  eye 
strain.  Dirty  or  improperly  ventilated  sur- 
roundings predispose  to  it. 


PRACTICE  or  MEDICINE.  81 

Symptoms:  Eyelids  red  and  swollen;  eyeball 
bloodshot;  sensation  of  roughness,  smarting,  and 
itching;  flow  of  tears. 

Treatment:  If  foreign  bodies  are  present,  re- 
move them  at  once  by  carefully  everting  the  eye- 
lid over  a  pencil  or  a  match  stick  covered  with 
cotton.  Tell  the  patient  to  look  down  or  to 
rotate  the  eyeball,  and  when  the  foreign  body 
appears  carefully  but  quickly  wipe  it  away  with 
the  point  of  a  cone  previously  prepared  from  a 
clean  handkerchief  or  gauze.  If  the  foreign  body 
is  under  the  lower  lid,  draw  this  lid  downward 
and  ask  the  patient  to  look  up.  For  inflamma- 
tion, thoroughly  wash  the  eye  with  a  medicine 
dropper  full  of  Boric  acid  solution,  then  foUow^ 
with  2  drops  of  the  Argyrol  solution.  Repeat 
this  treatment  2  or  3  times  a  day,  according  to 
the  severity  of  the  case. 

PURULENT    CONJUNCTIVITIS. 

Inflammation  of  the  eye  with  pus  (matter). 
This  form  of  conjunctivitis  is  due  to  microbic 
infection  and  is  most  dangerous  to  the  eyesight. 
The  severest  form  of  it,  due  to  infection  from 
gonorrheal  discharge,  is  often  present  in  newborn 
babies,  the  eyes  having  been  infected  by  dis- 
charges from  the  mother  during  labor. 


82  MEDICAL  HANDBOOK. 

Symptoms:  In  addition  to  those  of  simple  con- 
junctivitis, the  eyeUds  are  greatly  swollen,  so  that 
it  is  impossible  to  open  the  eye,  and  there  is  a  dis- 
charge of  pus  from  between  the  lids. 

Treatment:  This  pus  is  very  contagious,  and 
great  care  should  be  exercised  in  handling  such 
cases.  The  hands  of  the  person  treating  the  case 
should  be  well  washed  and  disinfected  in  a  Bi- 
chloride solution  1  to  1000.  All  bandages  and 
cotton  coming  in  contact  with  the  discharge 
should  be  burned,  and  the  family  must  be  warned 
in  regard  to  the  contagious  character  of  the  dis- 
ease, and  the  proper  manner  of  handling  the  case. 
In  cases  where  only  one  eye  is  affected  the  other 
should  be  protected  by  bandages,  and  in  small 
children  the  hands  should  be  tied  to  prevent  the 
possibility  of  carrying  the  disease  from  one  eye 
to  the  other  by  the  hands.  The  eyelids  should  be 
opened  sufficiently  to  admit  the  proper  instilla- 
tion of  the  solutions.  Wash  thoroughly  with 
Boric  acid  solution  until  all  signs  of  pus  have  dis- 
appeared, then  instill  the  Argyrol  as  mentioned 
in  simple  conjunctivitis.  This  treatment  should 
be  carried  out  every  2  hours. 

Between  the  treatments  the  application  of  ice 
to  the  eyelids  is  both  beneficial  and  soothing. 
The  ice  should  be  wrapped  in  clean  gauze  or 


PRACTICE  OF  MEDICINE.  83 

cloth.  Remember  that  this  is  one  of  the  most 
serious  conditions  of  the  eye,  and  a  physician 
should  treat  the  case  whenever  possible. 

To  prevent  the  disease  in  newborn  babies, 
where  the  mother  is  suspected  of  having  gonor- 
rhea, a  25  per  cent  solution  of  Argyrol  dropped 
into  the  eyes  of  the  infant  just  after  birth  and 
repeated  twice  a  day  for  2  days  is  effective.  As 
a  matter  of  precaution,  it  is  advisable  to  admin- 
ister this  treatment  to  all  babies,  as  it  is  abso- 
lutely harmless.  There  are  many  physicians 
who  practice  this  as  a  routine  treatment  at  all 
cases  of  confinement,  even  among  white  people. 
A  25  per  cent  solution  of  Argyrol  can  be  made 
by  dissolving  J  teaspoonful  of  Argyrol  in  4  tea- 
spoonfuls  of  water. 

CONJUNCTIVITIS   WITH   GRAY   SPOTS. 

This  is  a  form  of  inflammation  with  grayish 
white  spots  on  the  eyeball.  It  occurs  in  scrofu- 
lous children. 

Symptoms:  Small  grayish-white  (sometimes 
red)  spots  over  the  eyeball;  the  flow  of  tears  is 
increased;  the  symptoms  are  intensified  by 
bright  light;  pain  in  the  eyes  and  temples;  mass 
of  scar  tissue  on  the  lids.  Ulceration  of  the 
eyeball  is  a  serious  compHcation.     This  disease 


84  MEDICAL  HANDBOOK. 

is  chronic,   and  the  danger  of  ulceration  and 
impairment  of  the  vision  is  great. 

Treatment:  Wash  the  eye  3  times  a  day  with 
Boric  acid  solution  and  follow  with  Argyrol. 
Take  a  few  grains  of  calomel  or  Iodoform  powder 
on  the  end  of  a  card  and  dust  it  into  the  open  eye, 
and  then  gently  massage  the  closed  eye  in  order 
to  spread  the  powder  all  over  the  surface  of  the 
eyeball.  This  should  be  performed  2  or  3  times 
a  week.  Internal  medication  is  very  important 
in  these  cases.  Give  Syrup  of  Iodide  of  Iron 
in  doses,  to  children,  of  5  to  15  drops  after  meals; 
or,  where  this  is  not  obtainable,  substitute  for  it 
Syrup  of  Hypophosphites  Compound,  1  tea- 
spoonful  after  meals.  Protect  the  eyes  with 
colored  glasses. 

SNOW"    BLINDNESS    (sOLAR  CONJUNCTIVITIS). 

Snow  blindness  always  occurs  in  early  spring, 
as  a  direct  result  of  the  rays  of  the  sun  reflected 
from  the  snow.  This  condition  can  be  easily 
produced  artificially  by  reflecting  the  rays  of 
the  sun  from  a  small  mirror  directly  into  the 
eye  for  a  short  period. 

Symptoms:  Eyeballs  red,  the  superficial  blood 
vessels  greatly  distended;  pupils  contracted;  a 
sensation  as  of  sand  in  the  eyes;  pain  and  throb- 


PRACTICE  OF  MEDICINE.  85 

bing  behind  the  eyeball;  complete  or  partial 
blindness;  and  the  patient  staggers  as  if  under 
the  influence  of  alcohol. 

Treatment:  Snow  blindness  is  easily  prevented 
by  the  use  of  colored  glasses,  by  painting  around 
the  eye  with  soot,  by  using  a  dark-colored  mask 
(which  may  easily  be  made  from  a  black  or  blue 
handkerchief  or  piece  of  cotton  lining),  or  by 
using  the  Eskimo  snow  glasses,  made  of  wood  or 
bone,  with  a  slit  in  the  center.  The  medical 
treatment  consists  in  dropping  Argyrol  solution 
into  the  eyes  3  times  a  day;  cold  applications 
and  confinement  to  a  dark  room  for  2  days. 

GRANULATED    LIDS    (tRACHOMA). 

A  variety  of  conjunctivitis  with  granular  lids 
and  a  mucopurulent  discharge.  This  discharge  is 
the  medium  by  which  the  disease  is  carried  from 
one  person  to  another.  The  affection  is  chronic 
and  likely  to  impair  the  vision,  or  even  produce 
blindness. 

Symptoms:  The  earliest  symptoms  are  swollen 
lids,  with  a  profuse  mucopurulent  secretion. 
Later,  small,  red  granular  masses  cover  the 
entire  surface  of  the  lids;  these  finally  change 
to  scar  tissue. 


86  MEDICAL  HANDBOOK. 

Treatment:  Enforcement  of  personal  cleanli- 
ness and  the  use  of  individual  towels  should  be 
insisted  on  in  the  home  of  the  patient.  The 
family  should  be  thoroughly  instructed  in  regard 
to  the  contagious  character  of  the  disease  and 
the  method  of  preventing  it  from  spreading  to 
the  other  members  of  the  family.  Nourishing 
food;  outdoor  exercise;  frequent  washing  of  the 
eyes  with  Boric  acid  solution  and  the  use  of 
Argyrol  in  cases  where  pus  is  present. 

Trachoma  is  a  self -limited  disease  which  yields 
very  slowly  to  treatment  and  requires  the  care 
of  a  physician  for  a  long  time  to  effect  a  cure; 
cleanliness  will,  however,  prevent  any  defect  of 
vision  in  most  cases.  Trachoma  is  considered 
to  be  a  dangerous  contagious  disease  by  the 
Government,  and  immigrants  who  are  afflicted 
with  it  are  forbidden  entrance  into  the  United 
States.  Cases  of  trachoma  should  be  reported 
and  treated  by  a  physician. 

SKIN    DISEASE    OF    THE    EYELIDS. 

Eczema  is  one  of  the  most  common  of  the 
diseases  that  afflict  the  eyelids.  Inflammation, 
itching,  and  moisture  make  the  diagnosis  easy. 
Treatment:  For  simple  cases,  apply  Zinc  oxide 
ointment. 


PRACTICE  OF  MEDICINE.  87 

Erysipelas  of  the  Eyelids  occurs  during  the 
course  of  facial  erysipelas.  Treatment  should 
consist  of  applications  of  Ichthyoi  ointment 
over  the  eyelids. 

Blepharitis  Squamosa:  A  chronic  disease  of 
the  margin  of  the  eyelids,  characterized  by  the 
formation  of  scales  or  crusts,  the  falling  out  of 
the  eyelashes,  and  a  tenacious  secretion  which 
often  glues  the  eyelids  together.  Blepharitis 
occurs  in  anemia,  scrofula,  and  eruptive  fevers; 
from  neglect  of  cleanliness  and  from  exposure  to 
wind  and  dust.     It  is  not  contagious. 

Treatment:  This  depends  upon  the  cause. 
When  constitutional  treatment  is  needed.  Sirup 
Iodide  of  Iron  and  cod-liver  oil  are  indicated. 
Local  applications  are  useful  only  after  thorough 
removal  of  the  scales  and  crusts.  This  is  best 
accomplished  by  carefully  washing  the  margins 
of  the  lids  with  Boric  acid  solution;  after  drying 
apply  Ichthyoi  ointment  by  well  rubbing  it  along 
the  margins  of  the  lids  with  a  swab  composed  of 
a  toothpick  upon  which  a  piece  of  cotton  has 
been  wound.     Do  this  twice  a  day. 

EYELIDS — DISEASES   OF  THE   GLANDS. 

Styes  are  the  result  of  a  suppm^ative  inflam- 
mation of  the  glands  of  the  eyelids.  Swelling 
and  redness  occur  over  the  site  of  the  gland,  and 


MEDICAL  HANDBOOK. 


increase  for  a  few  days;  after  spontaneous 
evacuation  of  the  contents  all  inflammatory 
symptoms  rapidly  subside.  Treatment  consists 
in  hot  applications  over  the  eyelids. 

INJURIES    TO    THE    EYELIDS. 

The  eyelids  are  often  the  seat  of  wounds, 
burns,  and  scalds.  As  the  result  of  injuries  to 
the  eyelids  or  to  the  eyeballs,  abscesses  are  com- 
mon; and  as  the  result  of  burns  and  scalds, 
ulcers  sometimes  occur. 

Treatment:  The  best  treatment  immediately 
after  the  injury  is  the  application  of  ice  over  the 
closed  lids. 

INJURIES   TO   THE   EYEBALL. 

The  eyeball  is  often  injured  by  blows  and  falls, 
dust,  cinders,  etc.  Gunshot  wounds  may  pro- 
duce immediate  bhndness.  Injuries  to  the  eye- 
ball should  be  treated  according  to  the  rules  of 
surgery,  the  first  principle  of  which  is  that  the 
wound  and  everything  that  comes  in  contact 
with  it  should  be  absolutely  clean.  By  raising  or 
turning  the  lid  the  foreign  body  is  removed. 
Great  mischief  is  sometimes  done  by  applying 
poultices.  The  inflammation  produced  by  burns 
is  best  treated  with  cold  applications.     In  severe 


PRACTICE  OF  MEDICINE.  89 

injuries  the  lids  should  frequently  be  lifted  from 
the  eyeball  in  order  to  prevent  adhesion. 

HEMORRHAGE    OF   THE    EYEBALL. 

This  occurs  during  the  course  of  violent  cough- 
ing, vomiting,  and  in  old  age.  Injuries  to  the 
eyes  are  most  frequent  causes. 

Treatment:  Cold  applications  to  the  eye. 

PTERYGIUM. 

Pterygium  is  a  triangular-shaped  growth  over 
the  eyeball,  which  begins  in  one  corner  and  grad- 
ually grows  toward  the  pupil.  It  may  remain 
stationary  for  a  long  time  or  grow  until  it  covers 
the  pupil,  interfering  seriously  with  the  vision. 

Treatment:  A  pterygium  should  be  removed 
by  a  surgeon  when  it  obstructs  vision. 

KERATITIS. 

This  is  an  inflammation  of  the  cornea  of  the 
eye.  The  cornea  is  the  outer  membrane  of  the 
eye,  that  portion  encircled  by  the  white  mem- 
brane. The  pupil  is  located  in  the  center  of  the 
cornea.  The  cause  of  Keratitis  among  the  na- 
tives is  usually  inherited  syphilis,  germ  infection, 
or  injuries. 


90  MEDICAL  HANDBOOK. 

Symptoms:  In  Keratitis  there  is  pain  in  the 
eye,  especially  when  exposed  to  light,  excessive 
flow  of  tears,  and  some  inflammation  of  the  con- 
junctiva. The  cornea,  instead  of  being  clear,  is 
opaque  and  appears  to  be  sprinkled  with  minute 
gray  dots.  Ulcers  are  present  in  the  later  stages. 
The  result  of  neglected  treatment  is  defective 
vision  from  the  formation  of  opacities  over  the 
pupils. 

Treatment:  Keep  the  eye  clean  by  washing  with 
Boric  acid  solution,  after  which  use  ArgyroL 
Internally  give  Sirup  Iodide  of  Iron,  15  drops  to 
children  3  times  a  day;  and  2  Protiodide  of  Mer- 
cury pills  3  times  a  day  to  adults.  Regulate  the 
diet  and  bowels. 

CATARACT. 

Cataracts  are  very  prevalent  among  the  na- 
tives of  Alaska.  A  cataract  is  an  opacity  of  the 
lens.  It  is  generally  due  to  old  age,  but  may 
occur  in  younger  people  from  injury.  Do  not 
confuse  opacity  of  the  cornea  with  cataract. 
Cataract  appears  as  a  gray  spot  in  the  pupil, 
located  deep  in  the  eyeball.  A  corneal  opacity 
is  superficial,  irregular  in  shape,  and  may  extend 
beyond  the  margin  of  the  pupil;  it  is  a  result  of 
some  former  inflammation  of  the  cornea.     The 


PRACTICE  or  MEDICINE,  91 

vision  in  an  eye  with  cataract  gradually  dimin- 
ishes until  nothing  but  perception  of  light  is 
possible. 

Treatment:  The  only  treatment  is  surgical. 
Cataracts  can  be  removed  only  when  ripe,  and 
the  results  are  not  always  successful. 

Alivays  remember  that  the  eye  is  a  very  delicate 
organ,  one  which  even  a  general  practitioner  will 
hesitate  to  treat  when  a  specialist  is  at  hand. 
Therefore  he  careful  in  all  manipulations  about  the 
organ,  and  remember  that  cleanliness  is  the  key- 
note to  all  successful  treatment.  Refer  all  eye  cases 
to  a  physician  as  soon  as  possible. 

EARACHE. 

Earache  may  be  due  to  neuralgia,  impacted 
wax,  or  foreign  bodies  in  the  ear;  but  the  most 
common  cause  is  inflammation  of  the  middle  ear. 
Acute  inflammation  of  the  middle  ear  is  gener- 
ally preceded  by  sore  throat  and  slight  fever. 
Decayed  teeth  sometimes  cause  earache,  and 
should  promptly  be  attended  to  by  a  dentist. 

Treatment:  The  simplest  method  of  treating 
earache  is  by  the  application  of  dry  heat,  as  a 
hot-water  bag  or  hot  brick  or  plate  placed  over 
the  ear.  If  pain  is  not  relieved  by  this,  hot  irri- 
gations should   be  used   every  2   or  3   hours. 


92  MEDICAL  HANDBOOK, 

Hang  a  fountain  syringe  2  feet  above  the  pa- 
tient's head;  put  into  it  1  quart  of  hot  water  in 
which  a  tablespoonful  of  Boric  acid  has  been 
dissolved;  use  the  smallest  tip,  and  allow  the 
fluid  to  pass  into  the  ear  canal.  Catch  the  re- 
turning fluid  in  a  vessel  placed  under  the  ear. 
Wipe  the  ear  dry  with  cotton.  For  very  severe 
pain,  in  addition  to  the  above  give  J  grain  of 
Morphine  to  adults,  and  repeat  after  4  houis  if 
necessary. 

ECZEMA. 

Eczema  is  an  inflammatory,  noncontagious 
disease  of  the  skin,  which  is  prevalent  in  Alaska 
among  both  natives  and  white  people.  The  most 
characteristic  part  of  the  eczema  is  the  variety  of 
eruptions.  The  appearance  of  the  affected  skin 
varies  in  color  from  scabby  white  to  reddish 
violet.  The  eruption  varies  from  the  size  of  a 
pinhead  to  very  large  patches,  and  sometimes 
the  skin  cracks  deeply,  producing  open  wounds. 
In  some  cases  among  the  natives  the  skin 
becomes  like  tanned  leather,  and  the  eruption 
resembles  large  warts. 

Eczema  is  always  active,  varying  in  character 
in  the  same  patient  from  day  to  day.  It  usually 
begins  with  the  formation  of  a  few  blister-like 
vesicles,  red  and  swollen,  which  in  a  few  days 


PKACTICE  OF  MEDICINE.  93 

become  dry,  covering  the  skin  with  a  crust. 
About  a  week  later  this  crust  degenerates  and 
becomes  a  pasty  scab,  oozing  with  pus,  which 
soon  assumes  a  yellowish-brown  color.  The 
same  eruption  a  few  weeks  later  may  discharge 
bloody  serum. 

Eczema  is  generally  found  on  the  face,  hands, 
and  other  extremities,  but  no  portion  of  the 
body  is  free  from  its  attack.  Native  children 
suffer  with  eczema  of  the  face,  scalp,  nose,  ears, 
and  eyes.  Indigestion  and  fermentation  in  the 
stomach  are  common  causes  of  this  disease. 
Some  cases  are  of  nervous  origin. 

Treatment:  It  is  important  that  no  soap  or 
water  should  come  in  contact  with  the  skin 
lesion.  Wash  and  remove  the  crusts  with  olive 
oil  and  apply  Zinc  oxide  ointment  twice  a  day. 
In  cases  where  the  entire  face  is  affected,  cut 
a  mask  out  of  cheesecloth  or  sheeting,  spread 
the  ointment  on  this,  and  apply  to  the  face. 
Prevent  the  child  from  scratching  by  tying  the 
hands  or  by  applying  splints  along  the  arm  and 
forearm,  to  prevent  the  forearm  from  being 
flexed. 

The  diet  is  of  great  importance.  It  should  be 
light  and  must  not  contain  much  fat  or  starch. 
Alcohol,  tea,  and  coffee  are  absolutely  forbidden. 


94  MEDICAL  HANDBOOK. 

If  the  bowels  are  sluggish,  a  good  laxative  should 
be  administered  quite  often.  For  scrofulous 
children  suffering  with  eczema,  give  Sirup  Hy- 
phosphites  Compound,  J  teaspoonful,  3  times  a 
day. 

In  eczema  of  the  scalp.  Sulphur  ointment  is 
efficient,  providing  the  crust  is  softened  and  re- 
moved prior  to  the  application.  Where  crack- 
ing of  the  skin  occurs,  use  frequent  applications 
of  cod  liver  oil. 

EPISTAXIS  (NOSEBLEED). 

Nosebleed  is  a  symptom  in  many  diseases,  as 
anemia,  scurvy,  typhoid  fever,  diphtheria,  etc. 
It  is  most  common  at  the  age  of  puberty,  and  in 
females  may  replace  menstruation  wholly  or  in 
part. 

Treatment:  The  head  should  be  kept  erect. 
Applications  of  cold  (as  ice)  to  the  back  of 
the  neck  often  prove  effective.  Inject  into  the 
nostrils  salt  water,  vinegar,  or  lemon  juice. 
Hydrogen  Peroxide  has  been  fou,nd  a  reliable 
remedy  to  check  nosebleed  temporarily.  If,  in 
spite  of  these  measures  the  bleeding  continues, 
it  wiU  be  necessary  to  tampon  or  plug  the  nostril. 
A  soft  piece  of  cotton,  linen,  or  gauze  is  intro- 
duced into  the  nostril  and  packed  in  tightly. 


PRACTICE  OF  MEDICINE.  95 

ERYSIPELAS. 

This  disease  is  common  in  the  north.  It  is 
partly  due  to  poorly  ventilated  houses  and  lack 
of  cleanliness.  The  disease  itself  is  caused 
directly  by  the  germ  of  erysipelas  and  is  highly 
contagious.  It  is  characterized  by  a  peculiar 
swelling  of  the  skin,  generally  that  of  the  face 
and  neck.  This  swelling  is  dark  red,  and  has  a 
tendency  to  spread  and  become  puffy.  The 
border  of  the  swelling  is  sharply  defined.  It 
often  attacks  open  wounds,  and  is  not  uncommon 
in  poorly  ventilated  hospitals. 

Symptoms:  Sudden  chill,  followed  by  fever 
which  frequently  reaches  105°;  rapid  pulse; 
coated  tongue;  pain  in  the  extremities,  and  vio- 
lent headache ;  convulsions  may  occur  in  children. 
The  eruption  appears  at  first  as  a  red  spot  usu- 
ally on  the  side  of  the  nose,  spreading  rapidly, 
and  presenting  a  reddish-purple  glistening  ap- 
pearance. The  eyes  are  generally  closed  com- 
pletely, and  the  features  greatly  swollen  and  dis- 
torted.    Erysipelas  has  a  tendency  to  recur. 

Treatment:  Isolate  the  case  and  administer  a 
cathartic  at  once.  Local  treatment  consists  in 
painting  the  lesion  and  part  of  the  surrounding 
skin  with  pure  Tincture  of  Iodine.  The  healthy 
skin  is  treated  in  order  to  check  the  progress  of 


96  MEDICAL  HANDBOOK. 

the  disease.  In  applying  the  iodine,  care  should 
be  taken  not  to  drop  any  of  it  into  the  eyes ;  tell 
the  patient  to  keep  the  eyes  closed  while  making 
the  application.  After  this,  Ichthyol  ointment 
should  be  spread  on  a  cloth  and  applied  to  the 
face.  Where  the  use  of  iodine  causes  too  much 
pain,  the  ointment  should  be  used  alone  twice  a 
day.  Apply  iodine  once  every  other  day  until 
the  disease  is  checked.  Administer  internally 
Tincture  of  Iron,  15  drops  in  J  glass  of  water  3 
times  a  day.  In  cases  of  debility  give  Elixir  of 
iron,  quinine,  and  strychnine,  2  teaspoonfuls  to 
an  adult  every  4  hours.  While  attending  a  case 
of  erysipelas,  avoid  touching  or  dressing  any 
wound  or  abrasion,  or  you  may  convey  infection. 

GANGRENE. 

Gangrene  is  the  death  of  the  tissue  in  any  part 
of  the  body,  and  is  often  the  direct  result  of 
burns,  frostbites,  gunshot  wounds,  injuries,  etc. 
There  are  two  distinct  types  of  gangrene — ^moist 
and  dry. 

Moist  gangrene  is  accompanied  by  a  good  deal 
of  swelling,  pain,  and  rise  of  temperature.  The 
gangrenous  part  is  at  first  of  a  dark  red  color, 
which  quickly  changes  to  a  deep  purple  with 
greenish  spots,  surrounded  by  an  inflamed  area. 


PRACTICE  or  MEDICINE.  9^ 

Moist  gangrene  usually  ends  in  extensive  ulcera- 
tions with  a  very  offensive  discharge. 

Dry  gangrene  is  often  observed  in  Alaska  frora 
severe  frostbite.  It  usually  involves  the  extrem- 
ities. The  affected  parts  become  black,  shrink, 
and  dry  up,  resembling  the  appearance  of  a 
mimmiy.  These  parts  are  very  brittle  and  will 
often  break  as  easily  as  a  dry  twig. 

Treatment:  Moist  gangrene  should  be  bathed 
frequently  with  solution  of  Bichloride  of  Mer- 
cury, 1  to  4,000,  then  dried  thoroughly  and 
dusted  with  Iodoform.  In  the  majority  of  cases 
amputation  is  necessary. 

GONORRHEA  (CLAP). 

Gonorrhea  is  a  contagious  disease  of  the  gen- 
ital organs.  The  symptoms  are  a  sense  of  itch- 
ing or  heat,  discomfort  caused  by  m'inating, 
profuse  greenish-yeUow  discharge  from  the  gen- 
ital organ. 

Treatment:  Diet  should  consist  of  liquids,  and 
the  patient  should  be  encouraged  to  drink  plenty 
of  water.  Internally  give  Salol,  15  grains  every 
4  hours;  keep  the  patient  in  bed,  to  prevent  any 
complications.  Warn  him  concerning  the  con- 
tagious character  of  the  discharge  and  especially 
the  danger  of  carrying  the  infection  to  the  eye^ 

77037°— 13 r 


98  MEDICAL  HANDBOOK. 

by  his  hands.  Painful  urination  will  be  re- 
lieved by  immersion  of  the  genital  organ  in 
hot  water  when  emptying  the  bladder.  The 
scrotum  should  be  supported  by  a  suspensory 
bandage. 

INDIGESTION  (ACUTE). 

An  acute  inflammation  of  the  mucous  mem- 
brane of  the  stomach,  accompanied  by  loss  of 
appetite,  occasional  vomiting,  pain  in  the 
stomach,  and  constipation.  The  disease  is  most 
common  in  adults,  and  is  usually  caused  by 
improper  food  or  overeating. 

Symptoms:  Heavily  coated  tongue,  bad  taste 
in  the  mouth,  foul  breath,  vomiting  (at  times), 
headache,  and  a  feeling  of  weight  in  the  stomach, 
accompanied  by  colicky  pains. 

Treatment:  Give  a  teaspoonful  of  Wine  of 
Ipecac  every  10  minutes  until  vomiting  occurs; 
mustard  or  hot  salt  water  will  serve  the  same 
purpose.  Empty  the  bowels  with  calomel,  1 
grain.  Allow  the  stomach  to  rest  by  withholding 
food  for  24  hours,  after  which  give  liquids  only, 
and  gradually  return  to  regular  diet. 

HEADACHE. 

Headache  is  a  symptom  of  many  diseases. 
Therefore  treat  the  disease,  wherever  it  is  recog- 
nized, and  the  headache  will  be  relieved.    The 


FRACTICE  OF  MEDICINE.  99 

patent  headache  powders  sold  at  drug  stores 
usually  depend  on  Acetanilid  for  their  effect. 
They  are  dangerous  and  are  responsible  for  many 
deaths. 

Headaches  may  be  due  to  the  toxins  which 
develop  in  all  infectious  diseases;  in  these  cases 
thay  are  usually  of  short  duration. 

Headache  due  to  derangements  of  the  stomach 
is  usually  recognized,  as  the  pain  is  generally  very 
dull,  and  affects  the  forehead  mainly;  with  this 
there  is  a  heavily  coated  tongue. 

Nervous  headache,  or  migraine,  is  character- 
ized by  the  patient  complaining  of  discomfort 
and  distress  in  the  head,  more  than  of  actual 
pain.  This  discomfort  usually  disappears  as 
soon  as  the  patient  goes  to  sleep.  In  this  type 
of  headache  there  is  often  vomiting  unaccom- 
panied by  nausea.  Fainting  frequently  occurs 
and  usually  relieves  the  condition. 

The  headache  due  to  eyestrain  is  always 
accompanied  by  deep-seated  pain  in  the  eye- 
balls. It  is  always  increased  by  attempting  to 
read  or  write. 

Headaches  due  to  different  lesions  of  the  brain 
are  the  most  severe,  and  there  is  always  some 
deafness,  vomiting,  and  convulsions. 


100  MEDICAL  HANDBOOK. 

Treatment:  Toxic  headaches  seldom  require 
more  than  the  application  of  an  icebag  to  the 
head.  Migraine  should  be  treated  by  free  admin- 
istration of  Epsom  salts  and  Sodium  Salicylate, 
10  grains;  repeat  this  in  4  hours  if  pain  still 
continues.  If  pain  is  not  relieved  give  Potas- 
sium Bromide,  15  grains.  Headache  due  to 
derangement  of  the  stomach  is  best  treated  by 
regulating  the  diet,  and  by  cathartics,  adopting 
the  treatment  described  for  dyspepsia.  For 
headache  caused  by  eyestrain  the  patient  should 
consult  an  occulist.  Meantime  treat  as  you 
would  nervous  headache. 

For  headache  due  to  lesion  of  the  brain  use  an 
icebag  on  the  head,  and  give  Potassium  Bromide, 
15  grains  every  3  hours. 

HEART  DISEASE. 

Heart  diseases  are  either  organic  or  func- 
tional, and  may  occur  as  complications  in  other 
diseases.  A  proper  diagnosis  and  treatment 
can  be  determined  only  by  a  physician  after  a 
careful  examination  of  the  patient.  The  general 
symptoms  are  shortness  of  breath,  palpitation, 
shooting  pain  over  the  heart,  blue  lips,  dropsy. 

General  treatment:  Absolute  rest  in  bed  for  a 
number  of  days  allows  the  heart  to  rest  and  is  an 


PRACTICE  OF  MEDICINE.  101 

essential  part  of  the  treatment  of  all  forms  of 
heart  disease.  Regulate  the  bowels  and  re- 
strict the  diet.  For  distressing  shortness  of 
breath  give  Morphine,  J  of  a  grain  every  3  hours 
until  relieved ;  at  the  same  time  prop  the  patient 
up  in  bed  and  open  the  windows.  In  threatened 
heart  failure  give  1  teaspoonful  of  Aromatic 
spirits  of  ammonia  in  water  and  repeat  in  10 
minutes  if  necessary.  Apply  hot- water  bottles 
to  the  feet  and  body.  It  is  important  to  caution 
aU  persons  suffering  with  heart  disease  to  avoid 
violent  exercise. 

HEART  PALPITATION. 

Palpitation  (or  fluttering  action)  of  the  heart 
may  be  due  to  mental  excitement,  fright,  exces- 
sive use  of  tobacco,  alcohol,  coffee,  or  tea;  fre- 
quently to  gas  or  acid  in  the  stomach. 

Treatment:  Place  the  patient  in  bed  and  as- 
sure him  that  there  is  no  danger.  This  will  do 
much  to  restore  cheerfulness  and  shorten  the 
attack.  Apply  cold  compresses  or  icebag  over 
the  heart.  The  administration  of  Aromatic 
spirits  of  ammonia,  1  teaspoonful  in  water,  is 
useful. 


102  MEDICAL  HANDBOOK. 

HAEMOPTYSIS, 

(Hemorrhage  from  the  iung.) 

This  is  a  symptom  of  tuberculosis;  it  is  usually 
preceded  by  cough.  When  hemorrhage  occurs 
it  indicates  that  the  breaking-down  process  of 
the  disease  has  reached  some  blood  vessel  in  the 
lung;  the  amount  of  bleeding  depends  on  the  size 
of  the  vessel.  The  hemorrhage  rarely  causes 
death  when  it  occurs  during  the  early  stages  of 
the  disease.  Very  large  hemorrhages  are  caused 
by  rupture  of  a  large  vessel  and  may  be  imme- 
diately fatal.  Hemorrhages  from  the  lungs  may 
last  only  a  few  minutes  or  may  continue  for  sev- 
eral days.  All  bleeding  from  the  mouth  does  not 
necessarily  come  from  the  lungs,  but  may  result 
from  ulceration  of  the  stomach  or  gums.  Small 
streaks  of  blood  in  the  sputum  may  be  due  to 
nasal  cataiTh.  In  hemorrhage  from  the  lungs, 
the  blood  is  bright  r-ed,  foamy,  and  is  coughed 
up;  the  patient's  condition  indicates  lung  dis- 
ease. Blood  from  the  stomach  is  vomited  up 
and  is  of  a  dark  color,  often  mixed  with  food, 
and  the  patient  usually  complains  of  stomach 
trouble. 

Treatment:  Absolute  rest  in  bed;  ice  bag  over 
the  chest;  a  piece  of  ice  may  be  held  in  the  mouth 
and  slowly  swallowed.     As  coughing  increases 


PRACTICE  or  MEDICINE.  103 

hemorrhage,  Morphine  in  dose  of  J  of  a  grain 
may  be  given  to  quiet  it  (or  Dover's  powder,  5 
grains  every  3  horn's).  A  mild  laxative  may  be 
administered  to  relieve  blood  pressm'e. 

HEMORRHOIDS  (PHES). 

A  mass  of  dilated  or  varicose  veins  or  tag  of 
inflamed  skin  around  the  rectum.  The  most 
common  cause  of  piles  is  constipation. 

Treatment:  The  best  treatment  for  external 
piles  is  a  hot  compress,  to  relieve  pain  and  re- 
duce inflammation.  Sitting  over  a  vessel  of  very 
hot  water  is  soothing.  Locally,  apply  Ichthyol 
ointment.  In  some  cases  an  operation  may  be 
necessary.  It  is  essential  to  regulate  the  bowels 
to  produce  at  least  one  movement  a  day.  Give 
Extract  Cascara  Aromatic,  1  teaspoonful  at 
bed  time. 

HERPES  (COLD  OR  FEVER  BLISTER). 

Cold  sores  are  due  to  exposure  to  cold, 
typhoid  fever,  pneumonia,  or  disturbances  of 
the  stomach.  If  there  is  much  burning  and 
itching,  apply  Zinc  Oxide  ointment  or  cold 
cream. 

HERPES  ZOSTER  (SHINGLES). 

An  acute  inflammatory  disease  of  the  skin, 
characterized  by  neuralgic  pains  and  eruption  of 


104  MEDICAL  HANDBOOK. 

vesicles.  The  eruption  consists  at  first  of  a 
small  area  of  inflamed  skin,  bright  red,  and 
sensitive  to  pressure.  In  a  few  hours  vesicles 
appear,  containing  a  clear  fluid,  which  later 
becomes  cloudy  or  pustular.  In  two  or  three 
weeks  the  vesicles  usually  dry  up,  leaving  brown- 
ish scabs. 

Treatment:  Administer  a  cathartic.  Give  2 
Phenacetin  and  Salol  tablets  every  3  hours. 
Locally,  apply  Zinc  Oxide  ointment  twice  a 
day  or  paint  the  vesicles  with  Collodion. 

HIVES  (URTICARIA). 

This  is  a  sudden  general  eruption,  resembling 
severe  mosquito  bites;  is  associated  with  in- 
tense itching  of  a  stinging  character;  is  always 
of  short  duration  and  readily  yields  to  treat- 
ment. The  majority  of  cases  are  due  to  some 
disturbance  of  digestion.  Eating  strawberries, 
shell  fish,  or  oysters  may  produce  this  condition 
in  some  people. 

Treatment:  Regulate  the  diet.  Fluid  Extract 
Cascara  Sagrada,  1  teaspoonful  should  be  given 
every  night.  Sodium  Salicylate,  10  grains  every 
2  hours  for  3  doses.  Locally,  applications  of 
carbolized  vaseline. 


PRACTICE  OF  MEDICINE.  105 

INFANTILE  PARALYSIS. 

An  acute  infectious  disease  occurring  in 
children,  rarely  in  adults.  It  is  contagious  and 
occurs  in  epidemics,  sometimes  with  high  mortal- 
ity. It  has  been  demonstrated  recently  at  the 
hygienic  laboratory  of  the  Public  Health  Service 
that  infantile  paralysis  may  be  transmitted 
through  the  bite  of  the  stable  By,  which  is 
smaller  than  the  common  house  fly.  This  fact  is 
important  when  combating  an  epidemic  of  the 
disease.  Manure  piles  are  the  breeding  places 
of  these  insects,  and  should  not  be  tolerated  in 
any  community. 

Symptoms:  The  onset  is  sudden;  a  child  ap- 
parently well  is  attacked  during  the  night  with 
vomiting,  fever,  pain  in  the  head  and  along  the 
spine.  This  is  followed  by  paralysis;  either  the 
upper  or  lower  limbs,  or  both,  may  be  affected. 
The  location  and  extent  of  the  paralysis  depends 
upon  the  extent  and  location  of  the  inflammatory 
process  in  the  spinal  cord.  The  child  is  often 
unable  to  walk  or  to  raise  the  arms.  This  par- 
alysis gradually  improves  and  partial  function  of 
the  limbs  is  restored,  but  there  usually  remains 
some  permanent  paralysis.  In  some  cases  de- 
formities of  the  feet  and  hands  and  atrophy  of 
the  muscles  are  ultimate  results. 


106  MEDICAL  HANDBOOK.  . 

Treatment:  As  there  is  no  specific  for  this  dis- 
ease, treat  the  symptoms.  Isolate  the  patient 
and  destroy  by  burning  all  discharges  from  the 
nose  and  throat,  as  they  may  convey  the  con- 
tagion. Sponge  with  cold  water  to  reduce  fever, 
and  apply  an  ice  bag  to  the  spine.  Open  bowels 
with  castor  oil,  1  or  2  teaspoonfuls,  and  give  light 
diet.  The  disease  is  contagious  in  the  acute 
stage.  Three  weeks  after  the  onset  of  the  dis- 
ease the  paralyzed  limbs  should  be  massaged 
daily  with  chloroform  liniment,  and  a  teaspoon- 
ful  of  EHxir  of  iron,  quinine,  and  strychnine 
should  be  administered  3  times  a  day.  ; 

INFLUENZA  (LA  GRIPPE). 

An  acute,  contagious  fever  occurring  in  epi- 
demics and  associated  with  catarrhal  inflamma- 
tions. The  disease  is  due  to  bacteria.  The 
onset  is  sudden,  with  chills  and  fever,  pain  in  the 
joints  and  muscles,  shooting  pain  in  the  eyes, 
sneezing,  deafness,  bronchial  cough,  the  tongue 
furred;  vomiting  may  occur.  The  fever  de- 
clines in  5  or  6  days,  but  relapses  are  common. 
It  may  be  mistaken  for  a  "  bad  cold." 

Treatment:  Open  the  bowels  with  1  grain  of 
calomel;  then  give  Salol  and  Phenacetin,  2  tab- 
lets every  3  hours.     If  vitality  is  low,  administer 


PRACTICE  or  MEDICINE.  107 

Elixir  iron,  quinine,  and  strychnine,  1  teaspoonr 
ful  every  4  hours. 

JAUNDICE. 

Is  due  to  gallstones,  obstruction  of  the  bile  duct, 
or  inflammation  of  the  liver,  and  is  present  in 
some  febrile  diseases.  The  symptoms  are  coated 
tongue,  fetid  breath,  sense  of  fullness  after  eat- 
ing, sometimes  nausea  and  vomiting.  There  is 
always  constipation,  and  the  stools  are  light- 
colored  and  extremely  foul;  the  skin  and  eyes 
become  yellow. 

Treatment:  Exclude  from  the  diet  fatty  arti- 
cles. Milk  is  the  most  suitable  food.  Extract 
Cascara  Sagrada  Aromatic,  1  teaspoonful,  should 
be  given  twice  a  day,  or  calomel,  J  grain,  every 
hour,  till  bowels  move;  follow  with  Epsom  salts. 

KIDNEY  CONGESTION. 

May  be  caused  by  sudden  chilling  frorn  ex- 
posure to  cold,  or  be  due  to  diseases  of  the  hearty 
lungs,  or  liver,  or  due  to  pregnancy. 

Symptoms:  Dull  pain  in  small  of  the  back; 
scanty  urine,  which  may  sometimes  contain  a 
little  blood ;  the  pulse  is  increased,  and  there  is  a 
slight  variation  of  temperature. 

Treatment:  Liquid  diet;  the  patient  should  be 
kept  in  Ijed;  cloths  wrung  out  of  hot  water  may 


108  MEDICAL  HANDBOOK. 

be  applied  over  the  kidneys;  instruct  the  patient 
to  drink  water  freely;  Epsom  salts,  2  teaspoonfuls 
in  half  glass  of  water  every  day;  sweet  spirits  of 
niter,  10  drops  in  half  glass  of  water  3  times  a 
day. 

Diseases  of  the  kidneys  can  be  diagnosed  and 
treated  intelligently  only  after  an  examination 
Hof  the  patient's  urine. 

LICE. 

For  head  lice,  apply  equal  parts  of  kerosene 
and  olive  oil  to  the  scalp.  For  nits,  use  vinegar. 
Where  the  hair  is  long,  it  should  be  clipped. 

MEASLES. 

Highly  contagious;  the  poison  may  be  trans- 
mitted through  clothes  or  nasal  and  bronchial 
secretions;  incubation  period,  10  days;  pro- 
dromal stage,  3  days,  attended  by  running  of 
the  nose  and  eyes;  sneezing,  coughing,  and  rise 
of  temperature ;  slight  fall  of  temperature  on  the 
third  day,  after  which  it  rises  again.  Scaling  of 
the  skin  begins  about  the  fourteenth  day. 

Symptoms:  Cold  in  the  head,  persistent  sneez- 
ing, a  watery  discharge  from  the  nose,  red,  in- 
flamed eyes  with  flow  of  tears.  In  a  day  or  two 
a  cough  appears.  There  is  a  marked  elevation 
of  temperature.     The  eruption  appears  on  the 


PRACTICE  OF  MEDICINE.  109 

face  about  the  fourth  day  and  rapidly  spreads 
over  the  entire  body.  It  is  composed  of  small, 
dark-red  papules  in  groups.  In  the  hemorrhagic 
or  malignant  form  of  the  disease  (black  mea^ 
sles),  hemorrhages  occur  from  the  mucous 
membranes. 

Complications  in  measles  are  pneumonia 
(which  may  develop  into  tuberculosis),  whooping 
cough,  eye  and  ear  inflammations. 

Treatment:  The  contagious  nature  of  the  disr- 
ease  should  be  kept  in  mind,  and  proper  quaran- 
tine enforced.  Isolation  in  a  darkened  and  well- 
ventilated  room  is  imperative.  Administer  sweet 
spirits  of  niter,  5  drops  in  water  every  2  or  3 
hours.  When  the  cough  is  severe,  envelope  the 
chest  with  a  cotton  jacket  and  give  Brown  Mix- 
ture, 1  teaspoonful  every  2  hours.  The  thirst  is 
relieved  by  lemonade.  Drinks  are  to  be  given 
hot  if  the  eruption  is  tardy  in  making  Its  appear- 
ance. Milk  and  beef  juice  are  the  best  foods  in 
most  cases.  Relieve  constipation  by  enemas  of 
warm  water  or  by  castor  oil.  To  relieve  the 
itching,  rub  the  body  with  carbolized  vaseline. 
In  severe  cases  give  Aromatic  spirits  of  ammonia, 
15  drops  in  water  every  3  hours.  Treat  compli- 
cations as  they  arise. 


110  MEDICAL  HANDBOOK. 

MENINGITIS  (BRAIN  FEVER). 

Meningitis  is  an  inflammation  of  the  mem- 
branes of  the  brain  and  spinal  cord.  Its  causes 
are  injuries  to  the  skull,  tuberculosis,  syphilis, 
and  chronic  suppuration  of  the  middle  ear. 

Symptoms:  Fever  and  rapid  pulse,  persistent 
iieadaehe,  uncontrollable  vomiting,  dizziness  and 
delirium,  twitching  of  muscles,  retraction  of 
head,  with  rigidity  of  the  neck;  later,  uncon- 
sciousness. 

Treatment:  Calomel,  J  grain  every  3  hours. 
Epsom  salts  every  morning.  Icebag  to  the  head 
and  back  of  the  neck.  For  convulsions  in  adults : 
Morphine,  J  of  a  grain  every  4  hours;  for  chil- 
dren. Potassium  Bromide  10  grains  every  3  hours. 
Liquid  diet. 

MUMPS. 

Mumps  is  an  inflammation  of  the  salivary 
(parotid)  glands,  very  contagious  and  of  short 
duration.  The  symptoms  are  chills  and  moder- 
ate fever,  followed  by  a  swelling  below  and  in 
front  of  the  ear;  movements  of  the  jaw  are  pain- 
ful; often  the  inflammation  suddenly  subsides, 
to  reappear  in  the  testicles  in  the  male  or  in  the 
ovaries  or  breasts  of  the  female. 

Treatment:  Rest  in  bed;  cathartics;  isolate 
the  case  and  apply  Ichthyol  ointment  to  the 


PRACTICE  OF  MEDICINE.  Ill 

glands  twice  a  day;  cover  with  cotton  and 
bandage, 

NEURALGIA. 

Occurs  during  middle  life  and  is  generally 
hereditary.  The  symptoms  are  pain,  associated 
with  a  sensation  of  heat  or  burning;  in  many 
cases  a  marked  periodic  tendency;  pain  changes 
from  one  locality  to  another.  Any  nerve  of  the 
body  is  liable  to  be  attacked. 

Treatment:  1  teaspoonful  of  Fluid  Extract 
Cascara  Sagrada,  to  open  bowels;  external  ap- 
plication of  heat  to  the  seat  of  pain,  and  inter- 
nally 2  tablets  of  Salol  and  Phenacetin  every  4 
hours. 

NEURASTHENIA  (NERVOUS  PROSTRATION). 

:  A  peculiar  nervous  weakness,  associated  with 
loss  of  memory  and  energy  and  with  exhaustion. 
Even  a  small  amount  of  labor,  especially  mental, 
will  produce  great  fatigue  and  in  advanced  cases 
muscular  twitching,  and  sometimes  hysteria. 

Symptoms:  Headache,  with  tenderness  over 
the  scalp,  tenderness  along  the  spine,  numbness 
of  skin,  temporary  weakness  of  vision,  loss  of 
sexual  power,  imaginary  loss  of  memory,  fear  of 
possible  enemies,  insomnia. 


112  MEDICAL  HANDBOOK. 

Treatment:  Rest,  good  food,  change  of  scen- 
ery; Fluid  Extract  Cascara  Sagrada,  1  teaspoon- 
ful  at  bed  time;  Elixir  iron,  quinine,  and  strych- 
nine, 1  teaspoonful  before  meals. 

ORCHITIS. 

(Inflammation  of  the  testicles) . 

Inflammation  of  the  testicles  may  be  induced 
by  exposure  to  cold,  by  mumps,  or  injuries,  but 
the  most  common  cause  is  gonorrhea. 

Symptoms:  Dull  pain  in  the  groin,  slight  fever, 
nausea  and  faintness;  the  testicles  become  swol- 
len, red,  tense,  and  extremely  tender;  if  due  to 
gonorrhea,  there  is  a  yellowish  discharge  from 
the  urethra  before  swelling  appears. 

Treatment:  Rest  in  bed  is  essential;  locally  use 
flaxseed  poultices,  frequently  changed,  or  Ich- 
thyol  ointment.  Internally  a  moderate  dose  of 
Epsom  salts.  When  the  patient  recovers,  advise 
a  suspensory  bandage  to  prevent  recurrence.  If 
the  attack  is  due  to  gonorrhea,  give  Salol,  10 
grains  3  times  a  day. 

PERITONITIS. 

Peritonitis  is  inflammation  of  the  peritoneum 
(the  membrane  which  covers  the  intestines). 
This  membrane  is  very  sensitive  to  long  exposure 
to  cold  or  external  blows,  and  often  becomes 


PRACTICE  OF  MEDICINE,  113 

infected  from  perforation  of  the  intestines, 
stomach,  or  appendix.  Other  causes  are  tuber- 
culosis and  blood  poisoning. 

Symptoms:  Severe  pain  in  the  abdomen,  which 
is  very  sensitive  to  the  touch;  slight  chills  and 
fever;  nausea  accompanied  by  severe  vomiting, 
constipation;  the  abdomen  is  rigid  (hard)  and 
greatly  distended;  respiration  short  and  rapid. 

Treatment:  It  is  important  to  remember  that 
the  application  of  heat  (as  hot-water  bottles  or 
poultices)  is  injurious,  as  it  hastens  the  forma- 
tion of  pus.  A  rubber  bag  filled  with  finely 
cracked  ice  is  always  beneficial;  providing  it  is 
not  too  heavy.  For  adults,  Dover's  powder,  10 
grains  every  5  hours;  for  children  Tinctura  opii 
camphorata  (paregoric)  5  drops  every  3  hours. 
This  is  an  extremely  serious  disease,  and  the 
mortality  is  high. 

PLEURISY. 
(Pain  or  stitch  in  the  side.) 

The  membrane  which  envelops  the  lungs  is  a 
very  common  seat  of  painful  inflammation. 
The  pain  is  usually  sharp  and  stabbing  in 
character.  In  the  majority  of  cases  this  pain  is 
felt  on  the  side  near  the  nipple.  Pleurisy  is  a 
common  complication  of  all  lung  fevers,  infec- 

77037"— 13 8 


114  MEDICAL.  HANDBOOK. 

tious  diseases,  rheumatism,  and  consumption. 
In  many  cases  the  membrane  adheres  to  the 
surrounding  tissue  and  causes  chronic  pleurisy. 
Injuries  to  the  side  will  also  cause  it. 

Symptoms:  Dry  cough,  which  increases  the 
pain;  the  breathing  is  irregular  and  restricted; 
in  the  majority  of  cases  chills  and  fever  occur; 
the  pleura  has  a  tendency,  by  overproduction  of 
the  lubricating  fluid,  to  produce  effusion. 

Treatment:  Absolute  rest,  warmth,  light  diet^ 
administration  of  quinine,  5  grains,  with  5  grains 
of  Dover's  powder  every  3  or  4  hours.  Exter- 
nally, apply  over  the  seat  of  pain  a  mustard 
plaster  or  paint  with  iodine.  Great  relief  is 
obtained  by  strapping  the  affected  side  of  the 
chest  with  strips  of  adhesive  plaster  2  inches 
wide.  These  strips  should  be  applied  very 
tightly  and  overlap  each  other,  reaching  from 
the  breast  bone  to  the  spine.  Pleurisy  with 
effusion  requires  an  operation. 

PNEUMONIA. 

Lung  fever  is  usually  the  result  of  sudden  chill- 
ing of  the  body  and  subsequent  infection  by 
bacteria.  The  attack  may  weaken  the  lungs 
and  predispose  to  tuberculosis  or  recurrence  of 
the  disease  itself.  Pneumonia  in  drunkards  is 
nearly  always  fatal. 


PRACTICE  OF  MEDICINE.  115 

Syinptoms:  Distress  in  the  chest,  with  diffi- 
culty in  breathing;  severe  chills;  temperature 
rises  rapidly  and  reaches  104°  or  105°;  scanty 
urine;  respiration  becomes  rapid  and  soon 
reaches  from  40  to  60  per  minute;  the  pulse  is 
full  and  jerky.  The  most  prominent  symptom 
is  the  cough,  which  at  first  is  dry  but  is  soon 
accompanied  by  a  bloody  mucous  expectoration 
(rusty  sputum) ;  the  face  is  flushed ;  a  pleuritic 
pain  is  present  on  the  affected  side.  Usually 
but  one  lung  is  involved;  double  pneumonia  is 
invariably  fatal.  Delirium  is  present  in  some 
cases.  The  disease  usually  lasts  from  7  to  11 
days. 

Treatment:  As  the  mortality  in  pneumonia  is 
high,  especially  in  the  north,  and  as  death  is 
mostly  due  to  heart  failure,  it  becomes  our  first 
duty  to  see  that  proper  stimulation  is  adminis- 
tered from  the  start.  Use  Strychnine,  go  of  a 
grain  every  3  or  4  hours  for  adults;  for  children 
Aromatic  spirits  of  ammonia,  about  15  drops  in 
water  every  2  or  3  hours.  For  high  fever,  cold 
sponging  every  4  hours.  See  that  the  bowels 
move  regularly.  Cover  the  chest  with  a  cotton 
jacket  made  of  a  heavy  layer  of  cotton  batting, 
covered  by  muslin  and  held  in  place  securely 
with  safety  pins.     Give  quinine,  5  grains  every 


116  JIEDICAL  HANDBOOK. 

3  hours.  If  the  cough  is  troublesome,  give 
Brown  Mixtiu-e,  1  teaspoonful  3  or  4  times  a  day. 
The  diet  must  be  hquid.  On  recovery  the  pa- 
tient must  be  watched  carefully  for  a  long  time, 
and  Sirup  Iodide  of  Iron  in  half  teaspoonful 
doses  administered  3  times  a  day. 

PTOMAINE  POISONING. 

It  is  always  due  to  the  presence  of  ptomaines 
in  the  food  (particular^  in  canned  meats  or 
fish,  which  should  be  avoided  if  possible  on  this 
account).  Decomposed  fish,  especially  the  fish 
heads  which  the  natives  bury  before  eating, 
and  old  moose  meat  are  frequent  causes  of  this 
trouble. 

Symptoms:  Colicky  pains  in  the  stomach  and 
abdomen;  cramps  in  the  calves  of  the  legs; 
convulsions;  nausea  and  vomiting;  diarrhea, 
with  watery  (sometimes  bloody)  stools;  the 
abdomen  is  distended  by  gas;  the  pulse  always 
becomes  weak  and  rapid,  but  there  is  rarely 
any  perceptible  rise  of  temperature  (which 
sometimes  may  become  subnormal) . 

Treatment:  It  is  well  to  begin  by  administering 
an  emetic,  Wine  of  Ipecac  in  teaspoonful  doses 
every  10  minutes  until  vomiting  occurs.  After 
the  stomach  has  been  emptied,  give  1  grain  of 


PRACTICE  OF  MEDICINE.  117 

calomel  and  apply  hot  fomentations  or  hot- 
water  bottle  to  the  abdomen.  If  pain  and 
diarrhea  are  persistent,  give  Chloranodyne,  10 
drops  in  water  and  repeat  in  one-half  hour  if 
necessary.  Should  weakness  continue,  admin- 
ister Aromatic  spirits  of  ammonia,  30  drops  in 
water,  every  hour  or  two. 

All  food  should  be  withheld  for  at  least  12 
hours,  after  which  small  quantities  of  milk, 
broth,  chocolate,  etc.,  may  be  given  at  intervals 
of  2  or  3  hours. 

RICKETS  (RACHITIS). 

A  disease,  caused  by  lack  of  nutrition,  which 
affects  young  children,  causing  defective  devel- 
opment and  sometimes  deformities  of  the  bones. 
Predisposing  causes  are  heredity,  feeble  diges- 
tion, and  defective  assimilation,  poverty  and 
hardship,  tuberculosis,  S5^philis,  and,  most  im- 
portant to  us,  unhygienic  surroundings;  dark, 
filthy,  damp  huts,  without  ventilation  and  often 
overcrowded;  food  unsuited  to  the  age  and 
digestive  power  of  the  child,  such  as  decomposed 
fish,  game,  etc. 

Symptoms:  The  most  pronounced  early  symp- 
tom in  every  case  is  a  peculiar  sensitiveness  of 
the  child  to  touch;  there  seems  to  be  constant 


118  MEDICAL  HANDBOOK. 

deep-seated  pain  in  the  muscles  and  bones;  the 
child  is  irritable  and  seems  to  be  highly  nervous ; 
it  sleeps  poorly  and  is  often  disturbed  by  night- 
mares; the  digestion  is  poor;  the  abdomen 
becomes  greatly  distended;  the  secretion  of 
gastric  juice  seems  to  be  absent,  and  there  is 
always  an  excessive  formation  of  gas,  with  a 
tendency  to  nausea  and  vomiting ;  in  some  cases 
the  appetite  becomes  abnormally  large,  without 
any  apparent  beneJ&t  to  the  nutrition  of  the 
child;  there  is  always  a  marked  tendency  to 
decay  of  the  teeth;  in  advanced  cases  the  mus- 
cular weakness  becomes  so  pronounced  that  the 
child  refuses  to  move,  and  this  disinclination  to 
move  may  be  mistaken  for  paralysis.  All 
rachitic  children  have  a  tendency  to  profuse 
perspiration.  From  constant  lying  down,  the 
hair  becomes  thin,  and  falls  out ;  the  child  suffers 
from  cough,  as  in  scrofula;  the  eyes  are  inflamed 
and  there  is  enlargement  of  the  joints  and  soften- 
ing of  the  bony  structure.  The  head  of  the 
child  seems  to  be  abnormally  large  in  proportion 
to  the  body,  the  sutiu'es  are  open  and  the  head 
becomes  flat  on  top,  giving  an  appearance  of 
being  square. 

The  nervous   symptoms  become   more  pro- 
nounced  and   gradually   develop   into   convul- 


PRACTICE  OF  MEDICINE.  119 

sions;  there  is  twitching  of  the  muscles  of  the 
face,  which  as  the  disease  advances  becomes 
almost  constant;  the  outline  of  the  chest 
changes,  and  it  assumes  the  shape  of  a  pear  (so- 
called  pigeon  breast) ;  the  spine  is  frequently 
curved  and  softness  of  the  bones  predisposes  to 
bowlegs.  Throughout  the  different  stages  of 
rachitis,  the  child  may  suffer  either  from  diar- 
rhea or  constipation. 

Treatment:  Fresh  air  is  most  important;  the 
child  must  be  taken  out  of  doors  several  times 
each  day,  provided  the  weather  is  suitable; 
he  must,  of  course,  be  warmly  clad,  owing 
to  excessive  sweat  and  general  debility.  The 
dwelling  should  be  well  ventilated.  Food 
should  be  fresh  and  nutritious,  and  of  course 
well  cooked.  Digestion  should  be  aided  by 
Elixir  iron,  quinine,  and  strychnine  J  teaspoon- 
ful  before  meals.  For  constipation  give  J  tea- 
spoonful  of  Fluid  Extract  Cascara  Sagrada 
every  evening.  Cod  liver  oil  acts  as  a  tonic,  as 
well  as  a  food,  more  especially  if  it  is  reenforced 
by  Sirup  of  Hypophosphites  (cod  liver  oil,  1 
teaspoonful  with  Sirup  Hyphophosphites,  1 
teaspoonful  every  3  hours  during  the  day). 
Sponging  the  body  with  cold  salt  water  is  espe- 
cially beneficial  where  great  muscular  flabbiness 


120  MEDICAL  HANDBOOK. 

and  nervous  twitching  are  present;  be  sure  to 
rub  briskly  after  the  bath.  For  convulsions, 
give  Bromide  of  Potassium,  2  or  3  grains  dis- 
solved in  water.  The  diarrhea  is  controlled  by 
Bismuth  Subnitrate  5  grains,  with  the  addition 
of  1  or  2  drops  of  Camphorated  tincture  of 
opium  every  3  or  4  hours. 

RINGWORM. 

A  contagious  disease  of  the  skin;  caused  by  a 
vegetable  parasite.  The  symptoms  are  circular 
patches  of  the  skin  (reddened  rings)  with  clear 
centers;  some  itching;  slight  scaling.  For  treat- 
ment, paint  the  rings  with  Tincture  of  Iodine 
once  a  day. 

RHEUMATISM  (ACUTE). 

In  the  majority  of  cases,  rheumatism  is  the 
direct  result  of  prolonged  exposure  to  cold  or 
dampness.  As  a  rule  after  the  acute  symptoms 
Subside,  it  reappears.  Rheumatism  may  be 
acute  (with  fever)  or  chronic. 

Symptoms:  The  disease  usually  begins  abruptly 
with  chills  and  sore  throat.  The  large  joints 
become  swollen,  exquisitely  painful  and  tender 
to  the  touch.  The  inflammation  spreads  from 
joint  to  joint,  but  disappears  abruptly  in  one 
while  it  attacks  another.     Sometimes  the  muscles 


PRACTICE  OF  MEDICINE.  121 

are  rigid  and  painful.  The  fever  in  rheumatism 
(acute)  is  extremely  irregular  in  its  course. 
Profuse  perspiration,  with  a  sour  odor,  occurs. 
The  urine  is  highly  colored  and  scanty.  In  35 
per  cent  of  the  cases,  inflammation  of  the  heart 
(endocarditis)  occurs. 

Treatment:  A  patient  attacked  with  rheumatic 
fever  should  be  put  to  bed  between  woolen 
blankets  in  a  warm  room  free  from  drafts. 
Meats,  sweets,  wines,  and  liquors  should  be  for- 
bidden. Give  Sodium  Salicylate,  20  grains,  with 
plenty  of  water,  every  4  hours.  Local  treatment 
is  of  great  value.  Apply  freely  chloroform  lini- 
ment to  the  affected  limbs  and  wrap  in  cotton 
batting.  In  many  cases  the  application  of  heat 
to  the  attacked  parts  adds  to  the  patient's 
comfort. 

Lumbago  is  a  form  of  muscular  rheumatism  in 
the  loins  and  small  of  the  back;  it  is  frequently 
the  result  of  lifting  heavy  weights.  It  is  never 
complicated  by  inflammation  of  the  heart.  For 
treatment  apply  dry  heat  to  the  back  (or  a 
porous  plaster).  Sometimes  the  use  of  a  hot 
footbath  and  Dover's  powder,  10  grains  on 
going  to  bed,  will  cut  short  the  attack. 

In  chronic  rheumatism  a  change  of  residence  to 
a  dry,  warm  climate  may  effect  a  cure.     Give 


122  MEDICAL  HANDBOOK, 

Potassium  Iodide,  15  grains  3  times  a  day;  also 
use  local  applications  of  dry  heat  and  chloroform 
liniment.  If  Potassium  Iodide  is  not  tolerated 
by  the  patient,  give  Salol,  5  grains  every  3  hours. 

SCARLET  FEVER. 

This  is  a  highly  contagious,  eruptive  fever. 
The  complications  are  Bright' s  disease,  suppu- 
ration of  the  middle  ear,  and  pleurisy. 

Symptoms:  Vomiting;  chills  (or  convulsions), 
with  sudden  high  fever  and  pulse  ranging  from 
130  to  180.  After  24  hours  of  fever  the  eruption 
appears  as  a  bright  scarlet  rash  on  the  face  and 
neck,  at  first  in  the  form  of  minute  dots,  but  in 
24  hours  it  extends  over  the  entire  surface  of  the 
body.  The  appearance  of  the  patient  may  be 
likened  to  a  "boiled  crab."  This  remains  at  its 
height  for  4  or  5  days;  then  gradually  fades 
away.  A  scaling  of  the  skin  follows;  these 
scales  convey  the  contagion.  The  throat  symp- 
toms are  severe  from  the  onset;  the  tonsils  are 
enlarged  and  may  be  covered  with  dirty  mem- 
brane; the  tongue  is  red  and  covered  with 
papillae  resembling  a  strawberry.  The  mor- 
tality in  scarlet  fever  is  15  per  cent. 

Treatment:  The  patient  should  be  quarantined 
at  once.     To  allay  itching  and  prevent  the  scales 


PRACTICE  OF  MEDICINE.  123 

from  scattering,  the  skin  should  be  anointed 
with  carboHzed  vaseline.  For  fever  give  spirits 
of  niter,  J  teaspoonful  in  water  every  3  hours, 
and  sponge  the  body  twice  a  day  or  oftener  with 
cold  water.  For  weakness  or  heart  failure  give 
Elixir  iron,  quinine,  and  strychnine  in  teaspoon- 
ful doses  every  2  or  3  hours.  To  relieve  the  in- 
flammation of  the  throat,  give  cracked  ice. 
Swab  the  throat  with  Peroxide  of  Hydrogen. 
The  patient  should  be  encouraged  to  drink  water 
freely.  Keep  the  bowels  active  with  Epsom 
salts. 

SCROFULA. 

Scrofula  is  a  disease  of  infancy  and  childhood, 
and  is  due  to  a  variety  of  causes.  Almost  any- 
thing which  lowers  the  vitality  may  produce  it. 
Hereditary  syphilis  is  often  responsible,  but  the 
most  common  cause  is  insufficient  nourishment 
and  want  of  exercise  in  the  open  air.  Scrofula 
is  sometimes  a  hereditary  disease  which  remains 
in  the  same  family  for  many  generations.  The 
poor  quality  of  the  mother's  milk  or  artificial 
food  lacking  proper  ingredients  for  the  child's 
nourishment  and  growth  may  be  responsible 
for  it. 

Symptoms:  Marked  enlargement  of  the  neck 
glands,  which  may  eventually  become  soft  and 


124  MEDICAL,  HANDBOOK. 

form  abscesses.  These  are  slow  in  healing  and 
leave  permanent  scars.  All  cases  exhibit  some 
form  of  derangement  of  the  stomach.  There  is 
a  marked  tendency  to  eczema  of  the  face  and 
scalp.  Bronchitis,  conjunctivitis,  and  inflam- 
mation of  different  joints  are  common  complica- 
tions. Inflammation  of  the  ears  and  loss  of 
hearing  are  not  uncommon.  The  eyelids  are 
thickened  from  constant  inflammation  and  ul- 
cerations of  the  eyeball  are  common. 

Treatment:  The  manifestation  of  scrofula  is 
sometimes  of  short  duration.  This  disease 
readily  yields  to  proper  hygienic  and  medical 
treatment.  Cod-liver  oil  is  the  best  remedy. 
Reenforce  the  cod-liver  oil  with  Sirup  of  Iodide 
of  Iron,  which  must  be  given  separately,  for  the 
two  remedies  are  incompatible.  Give  Sirup  of 
Iodide  of  Iron  in  15-drop  doses  before  meals,  and 
2  teaspoonfuls  of  cod-liver  oil  after  eating. 
Personal  cleanliness,  fresh  air,  and  nourishing 
food  are  of  the  first  importance.  For  the  en- 
larged neck  glands  apply  Ichthyol  ointment. 
Should  the  glands  become  soft  and  filled  with 
pus,  a  free  incision  is  necessary.  Treat  the  eye 
symptons  and  eczema  of  the  scalp  and  face  in 
scrofula  as  described  in  chapter  on  eczema  and 
eye  disease. 


PRACTICE  or  MEDICINE.  125 

SCURVY. 

The  occurrence  of  scurvy  in  x\laska  is  becoming 
less  frequent  every  year.  Scurvy  is  not  entirely 
due  to  dried  and  salted  meats,  but  to  lack  of 
variety  in  food  generally.  It  still  occurs  here 
sometimes  in  infants  who  are  fed  on  condensed 
milk  or  artificial  food.  Breast-fed  babies  do 
not  contract  the  disease. 

Symptoms:  Spongy,  bleeding  gums  and  foul 
breath.  Teeth  become  loose  and  fall  out. 
Hemorrhages  from  the  stomach  and  bowels. 
Pain,  tenderness,  and  swelling  of  the  joints  may 
be  present. 

Treatment:  An  immediate  change  of  diet  to 
one  in  which  an  abundance  of  vegetables,  fruits, 
potatoes,  cabbage,  or  fruit  acid  is  supplied; 
make  free  use  of  Citric  acid  in  water  (or  lemon 
juice).  Give  Tincture  Iron  Chloride,  5  drops  in 
water,  3  times  a  day.  For  the  spongy  and 
bleeding  gums,  use  mouthwash  with  a  little 
alum,  or  Peroxide  of  Hydrogen,  25  per  cent. 
Infants  with  scurvy  should  not  be  kept  on  an 
exclusive  diet  of  artificial  food  or  milk.  Give  a 
little  baked  apple,  or  raw  scraped  apple,  fresh 
meat  juice,  or  broth  and  eggs. 


126  MEDICAL,  HANDBOOK. 

SMALLPOX. 

Smallpox  is  a  highly  contagious,  eruptive  dis- 
ease of  high  mortality.  Formerly  the  epidemics 
were  very  much  dreaded,  but  vaccination  has 
proved  to  be  a  great  prophylactic  measure,  and 
minimized  the  danger  of  infection. 

Symptoms:  The  disease  begins  with  chills, 
headache,  backache,  vomiting,  and  fever  which 
lasts  3  or  4  days.  The  eruption  then  appears, 
remains  for  a  week,  and  is  followed  by  a  secondary 
rise  of  temperature.  The  face  is  swollen,  the 
eyes  closed  from  the  inflammation;  cough  may 
be  present. 

Character  of  eruption:  Eruption  appears  on  the 
third  day,  first  on  the  forehead  and  lips;  it 
resembles  red  papules,  which  are  hard  and  feel 
like  shot  imbedded  beneath  the  skin.  These 
gradually  change  to  vesicles  and  finally  to  pus- 
tules with  a  depression  in  the  center.  In  severe 
cases  hemorrhage  occurs  under  the  skin. 

When  a  case  of  smallpox  appears  notify  the 
physician  or  the  district  superintendent.  In 
the  meantime  isolate  the  case  to  prevent  any 
one  coming  in  contact  with  it. 

Treatment:  The  patient  should  be  put  to  bed, 
the  bowels  opened  freely,  and  only  liquid  diet 
given.     The  headache  is  relieved  b}^  local  cold 


PRACTICE  OF  MEDICINE.  127 

applications  and  by  Salol  and  Phenacetin  tablets, 
2  every  3  hours.  For  the  fever,  sponge  the  body 
with  cold  water,  give  cool  drinks  and  quinine,  5 
grains  every  3  hours.  Irrigate  the  eyes  with 
Boric  acid  solution  if  necessary.  For  sleepless- 
ness give  15  grains  of  Potassium  Bromide  at 
night.  The  mouth  and  nose  should  be  kept 
clean  with  a  solution  of  Boric  acid.  To  prevent 
the  skin  from  pitting,  scratching  must  be  pre- 
vented. For  the  itching  apply  carbolized  vase- 
line twice  a  day.  For  depression  which  is  apt  to 
follow  give  Elixir  of  iron,  quinine,  and  strych- 
nine in  teaspoonful  doses  every  3  hours. 

Vaccination. — When  an  outbreak  of  smallpox 
occurs,  every  one  in  the  locality  should  be  vacci- 
nated and  an  absolute  quarantine  maintained.  For 
uniformity  the  left  arm  is  usually  selected,  the 
site  of  the  vaccination  being  the  outer  surface 
of  the  upper  third  of  the  arm.  Carefully  cleanse 
the  spot  with  soap  and  water  and  wipe  dry. 
Do  not  use  any  antiseptic  solution,  as  this  pre- 
vents it  from  ^Haking."  The  skin  should  be 
scratched  and  cross  scratched  with  an  antiseptic 
needle  or  a  special  scarifyer,  which  is  furnished 
with  the  virus.  Be  careful  not  to  cause  bleed- 
ing, for  it  is  not  necessary;  just  scrape  the 
upper  layer  of  the  skin  and  produce  oozing  of 


128  MEDICAL  HANDBOOK. 

the  serum.  The  skin  scraped  should  not  exceed 
J  inch  in  diameter.  The  virus  is  then  rubbed  in 
and  allowed  to  dry.  A  shield  for  protection  of 
the  wound  may  be  applied,  but  is  not  necessary; 
a  clean  bandage  will  answer  the  purpose.  Never 
use  the  same  needle  for  scratching  two  persons' 
arms  without  first  sterilizing  it  in  boiling  water. 
The  hands  of  the  vaccinator  should  be  scrupu- 
lously clean,  and  it  is  best  for  one  person  to 
clean  and  prepare  the  arms  while  another  does 
the  vaccination. 

Symptoms  following  vaccination:  Two  or  three 
days  after  vaccination  a  reddened  papule  ap- 
pears. This  gradually  increases  in  area,  be- 
comes paler  in  the  center  and  raised  at  the 
edges,  with  an  inflamed  areola;  about  the  fifth 
day  it  is  transformed  into  a  vesicle.  About  the 
twelfth  day  the  vesicle  dries,  forming  a  scab, 
which  later  becomes  detached,  leaving  a  per- 
manent scar.  During  the  development  of  the 
vesicle  there  may  be  nausea,  vomiting,  head- 
ache, and  some  elevation  of  temperature. 

Complications:  An  infection  of  the  arm  may 
occur  from  bad  technique  or  subsequent  infec- 
tion of  the  wound.  The  treatment  of  this  con- 
dition is  cleansing  the  wound  daily,  dusting  with 


PRACTICE  OF  MEDICINE.  129 

Boric  acid,  and  covering  with  clean  gauze  and 
bandage. 

Revaccination:  While  the  immunity  conferred 
against  smallpox  is  usually  efficient  for  some 
time  after  vaccination,  it  is  diminished  after  a 
number  of  years.  Occasional  revaccination  be- 
comes necessary.  It  is  always  advisable  to  re- 
vaccinate  every  one  upon  exposure  to  smallpox 
or  in  the  presence  of  an  epidemic. 

SORE  THROAT. 

Sore  throat  is  not  a  disease,  but  one  of  the 
symptoms  of  a  great  many  local  and  constitu- 
tional diseases.  It  may  be  due  to  a  common 
cold,  tonsillitis,  diphtheria,  syphilis,  infectious 
fevers,  or  rheumatism.  Under  this  heading  will 
be  described  the  sore  throat  caused  by  a  com- 
mon cold. 

Symptoms:  Pain  on  swallowing,  with  constant 
desire  to  clear  the  throat;  hoarseness;  slight 
cough  and  stiffness  of  the  muscles  of  the  neck; 
pain  over  the  whole  body,  with  slight  fever. 
Upon  examination  the  throat  and  tonsils  are 
found  to  be  red  and  swollen. 

Treatment:  Rest  in  bed;  hot  foot  bath  and 
Dover's  powder,  10  grains,  with  the  addition  of 
quinine,  3  grains,  at  night;  a  weak  solution  of 

77037°— 13 9 


130  MEDICAL  HANDBOOK. 

Hydrogen  Peroxide,  or  even  common  salt,  makes 
a  good  gargle ;  cold  compresses  around  the  throat 
are  of  great  value;  a  good  laxative  helps  to 
shorten  the  attack. 

STOMATITIS  (SORE  MOUTH). 

A  disease  of  childhood  characterized  by  in- 
flammation of  the  mucous  membrane  of  the 
mouth.  It  is  always  associated  with  slight  dis- 
turbance of  the  digestion  or  lack  of  cleanliness 
of  the  teeth,  gums,  and  mouth. 

Treatment:  Wash  the  mouth  frequently  with 
Hydrogen  Peroxide,  50  per  cent,  or  a  solution 
of  Boric  acid.     Regulate  the  diet  and  bowels. 

SWEATING. 

Excessive  sweating  may  be  caused  by  the  use 
of  alcohol  or  drinking  too  freely  of  ice  water, 
etc.  It  may  be  local  or  general.  The  hands, 
scalp,  and  feet  are  especially  likely  to  perspire 
freely.  This  is  one  of  the  symptoms  of  rheuma- 
tism, blood  poisoning,  and  consumption.  Offen- 
sive sweating  is  due  to  decomposition  of  sweat. 

Treatment:  The  skin  should  be  kept  clean  by 
daily  bathing  with  soap  and  water.  For  offen- 
sive sweating  of  the  hands  and  feet,  dust  with 
Boric  acid  or  Talcum  powder. 


PRACTICE  OF  MEDICINE.  131 

SYPHILIS. 

Syphilis  is  a  constitutional  disease  usually 
acquired  by  sexual  contact  and  is  due  to  infec- 
tion by  specific  germs.  It  may  be  transmitted 
by  infected  cups  and  dishes,  by  kissing,  or  it 
may  be  inherited  from  parents  (hereditary 
syphilis) . 

SYMPTOMS. 

Primary  stage:  A  chancre  appears  on  the  penis, 
or  the  inner  surface  of  the  labium  in  the  female, 
sometimes  on  the  lips,  not  earlier  than  three 
weeks  after  infection.  Any  sore  appearing  ear- 
lier than  this  time  after  exposure  is  not  a  hard 
chancre,  but  a  chancroid,  which  is  not  syphi- 
litic, but  only  a  local  sore.  The  chancre  is  a 
single  round  induration,  hard,  painless,  and 
with  little  or  no  secretion;  the  glands  in  both 
groins  are  usually  enlarged  (bubo) . 

Secondary  stage:  Five  or  six  weeks  after  its 
appearance  the  chancre  heals;  the  patient  is 
troubled  with  indigestion  and  weakness;  there  is 
slight  fever  and  headache,  with  pain  in  the 
bones;  sore  throat  with  ulcerations;  rose-colored 
eruption  all  over  the  face  and  entire  surface  of 
the  body;  an  eruption  appears  upon  the  mucous 
surfaces,  especially  of  the  mouth  and  throat; 
these  patches  of  eruption  are  extremely  conta- 


132  MEDICAL  HANDBOOK. 

gious,  and  the  disease  is  frequently  communi- 
cated by  kissing  or  by  the  use  of  cups,  knives, 
forks,  etc.  In  the  later  stages  falling  of  the  hair 
and  enlargement  of  the  glands  occur. 

The  tertiary  stage  seldom  manifests  itself  before 
the  second  year,  and  only  in  cases  which  have 
received  insufficient  treatment  or  none  at  all. 
The  symptoms  of  this  stage  are  ulcerations  of 
the  skin  and  mucous  membranes  of  the  nose 
and  palate,  with  necrosis  of  the  bones.  Paraly- 
sis and  insanity  result  from  the  destructive 
changes  in  the  nervous  system. 

In  hereditary  syphilis  the  signs  are  not  usually 
manifested  until  3  or  4  weeks  after  birth.  The 
typical  eruption  then  appears  on  the  skin,  with 
sores  behind  the  ears  and  about  the  corners  of 
the  mouth  and  with  mucous  patches  about  the 
buttocks.  There  is  constant  nasal  discharge. 
The  face  presents  a  senile  appearance;  the  skin 
is  wrinkled,  and  there  is  wasting,  debility,  and 
fretfulness.  If  the  child  lives,  notched  teeth  and 
inflammation  of  the  eyes  (keratitis)  develop 
later. 

TREATMENT. 

The  treatment  of  syphilis  among  the  natives  is 
unsatisfactory,  as  they  do  not  realize  the  serious- 
ness of  the  disease,  nor  the  necessity  of  faithful 


PEACTICE  or  MEDICINE.  133 

and  prolonged  treatment.  This  disease  can  be 
treated  intelligently  only  under  the  supervision 
of  a  physician.  However,  there  are  cases  that 
have  to  be  treated  by  the  laity,  and  for  these  the 
following  treatment  is  recommended: 

First  stage:  Keep  the  sore  clean  and  dry,  dust 
with  calomel  powder  once  a  day. 

Secondary  stage:  Begin  treatment  as  soon  as 
this  stage  is  manifested,  by  giving  Protiodide  of 
Mercury,  pill,  |^  of  a  grain,  3  times  a  day  after 
meals.  The  next  day  give  2  pills,  3  times  a  day, 
and  continue  to  add  1  pill  to  each  dose  every  day 
until  the  patient  complains  of  sore  mouth  and 
gums  and  a  metallic  taste  in  the  mouth;  this 
indicates  that  the  physiological  limit  of  the  drug 
has  been  reached.  Then  reduce  the  number  of 
pills  one-half  and  continue  them  3  times  a  day. 
If  the  mouth  symptoms  persist,  discontinue  the 
treatment  until  they  disappear,  after  which  it 
should  be  resumed.  As  a  mouthwash  use  a 
gargle  of  Peroxide  of  Hydrogen  50  per  cent. 
After  3  or  4  months  of  the  mercury  treatment, 
add  10  grains  of  Potassium  Iodide  to  the  dose  of 
mercury.  Dust  the  mucous  patches  with  calo- 
mel. 

Tertiary  stage:  Give  large  doses  of  Potassium 
Iodide;  begin  with  5  grains  3  times  a  day  and 


134  .    MEDICxlL  HANDBOOK. 

increase  gradually  up  to  25.  Watch  the  effect 
on  the  stomach,  and  if  digestion  is  impaired, 
stop  the  medicine  for  a  week,  and  then  resume. 
Wash  the  ulcers  daily  with  Boric  acid  solution, 
apply  mercurial  ointment,  and  bandage. 

Hereditary  syphilis  in  children:  Give  Sirup 
Iodide  of  Iron,  10  to  15  drops  3  times  a  day;  rub 
well  into  the  abdomen  Mercurial  ointment  about 
the  size  of  a  pea  2  or  3  times  a  week,  and  cover 
with  binder. 

A  patient  suffering  with  syphilis  should  be 
under  treatment  and  observation  of  a  physician 
at  least  one  year. 

The  new  remedy,  Salvarsan  (606),  is  the  treat- 
ment par  excellence  for  the  native,  as  one  injec- 
tion is  equivalent  to  several  months'  treatment 
with  mercury.  It  is  to  be  hoped  that  it  will  be 
possible  to  administer  Salvarsan  to  the  natives 
in  the  near  future.  This  remedy  can  be  given 
properly  only  by  an  experienced  physician,  and 
in  a  hospital. 

SUPPURATION  OF  THE  EAR. 

(Running  ear.) 

Inflammation  of  the  middle  ear  may  be  due  to 
slight  congestion  or  to  infection  by  various  bac- 
teria.    When  the  infection  is  due  to  bacteria,  it 


PRACTICE  OF  MEDICINE,  135 

always  ends  in  the  formation  of  pus,  which  soon 
becomes  so  abundant  that  the  drum  membrane 
ruptures,  and  there  is  a  constant  discharge  of 
thick,  yellow  matter.  The  various  infectious 
diseases,  more  especially  those  which  affect  the 
mucous  membrane  of  the  mouth,  invariably  at- 
tack one  or  both  ears.  The  habit  which  many 
people  have  of  cleaning  and  poking  the  ears  with 
earspoons,  hairpins,  and  other  objects  scratches 
and  injures  the  membrane  and  renders  it  liable 
to  infection;  enlarged  tonsils  and  adenoids  favor 
its  occurrence.  Violent  sneezing  or  blowing  of 
the  nose  sometimes  forces  infected  secretions  into 
the  middle  ear,  or  by  its  violence  ruptures  the 
drum  membrane. 

Suppuration  of  the  ear  is  one  of  the  common 
complications  in  measles,  diphtheria,  and  scarlet 
fever. 

In  all  cases  where  purulent  discharges  are 
present  (except  where  the  pus  is  due  to  small 
boils  forming  in  the  external  canal,  and  which 
may  be  seen  by  reflecting  light  from  a  small 
mirror  into  the  external  ear),  you  may  take  it  for 
granted  that  the  drum  membrane  is  ruptured. 

The  drum  membrane  is  not  the  essential  organ 
of  hearing,  as  people  with  ruptured  drums  often 
hear  quite  well.     It  is  merely  one  of  the  factors 


136  MEDICAL  HANDBOOK. 

in  sound  transmission.  A  drum  membrane 
which  is  incised  by  a  physician  for  the  purpose  of 
draining  pus  from  the  middle  ear  heals  more 
quickly  than  one  which  ruptures  spontaneously. 

A  running  ear  is  really  a  very  serious  condition, 
for  not  only  will  the  hearing  become  impaired  if 
the  condition  is  not  treated,  but  the  disease  will 
progress,  with  destruction  of  the  bony  structure, 
and  may  finally  reach  the  brain,  causing  menin- 
gitis or  brain  abscess,  which  may  prove  fatal. 

The  symptoms  of  inflammation  and  suppura- 
tion of  the  ear  are  identically  the  same  that  are 
(ound  in  any  abscess.  These  are  chills,  fever, 
pain,  throbbing  when  pus  is  forming,  etc.  (to 
understand  them  better,  read  description  of 
abscess) . 

Treatment:  (See  also  chapter  on  earache.) 
After  the  ear  drum  ruptures  and  the  pus  begins 
to  flow,  the  ear  should  be  irrigated  with  hot 
Boric  acid  solution  (2  teaspoonfuls  to  a  pint  of 
water)  every  3  or  4  hours.  No  discharge  should 
be  allowed  to  accumulate  as  it  may  infect  the 
face  or  hands  and  produce  eczema. 

Never  use  a  solution  of  Hydrogen  Peroxide  in 
the  ear  as  this  generates  gas,  the  pressure  from 
which  is  apt  to  force  the  pus  into  the  deeper 
portions  of  the  ear.     Likewise,  when  syringing 


PRACTICE  OF  MEDICINE.  137 

the  ear,  be  gentle  in  all  manipulations  and  do  not 
permit  the  solution  to  enter  the  canal  with  suffi- 
cient force  to  produce  pain.  If  a  fountain 
syringe  is  used,  it  should  be  lowered.  Internally 
give  Elixir  of  iron,  quinine,  and  strychnine,  1 
teaspoonful  3  times  a  day,  or,  what  is  preferable, 
10  to  15  drops  of  Sirup  of  Iodide  of  Iron.  If 
eczema  develops  apply  Zinc  oxide  ointment. 

TEETHING  IN  INFANCY. 

As  a  rule  teething  in  infancy  is  associated  wath 
comparatively  little  disturbance.  On  the  other 
hand,  this  condition  may  produce  convulsions, 
which  are  sometimes  fatal. 

Symptoms:  Increased  flow  of  saliva;  the  child 
is  restless  and  feverish  and  often  cries;  the  gums 
as  a  rule  are  inflamed,  and  the  child  exhibits  a 
desire  to  bite;  in  some  cases  the  child  becomes 
suddenly  stiff  and  pale,  the  head  is  thrown  back- 
ward, and  convulsions  follow. 

Treatment:  Place  the  child  in  a  hot  bath  at 
once,  and  let  it  remain  for  5  or  6  minutes,  then 
remove  and  wrap  in  hot  flannel  blankets. 
Give  an  anema  of  warm  soapsuds  and  2  grains 
of  Bromide  Potassium  b}^  mouth.  Lancing  the 
gums  is  sometimes  necessary. 


138  MEDICAL  HANDBOOK. 

TEETH. 

As  the  native  of  Alaska  is  usually  unable  to 
obtain  the  services  of  a  dentist,  it  becomes  all 
the  more  necessary  to  preserve  his  teeth  by  con- 
stant cleanliness.  Every  teacher  should  instruct 
the  pupils  regarding  the  care  of  the  teeth.  (Con- 
sult books  on  hygiene.)  The  teeth  of  children 
should  be  frequently  examined  for  the  purpose 
of  detecting  deformities  in  growth.  A  large  per- 
centage of  deformed  faces  are  due  to  the  effects 
of  double  teeth  (where  the  second  set  are  cut 
before  the  first  have  disappeared).  In  these 
cases  the  milk  teeth  should  be  extracted  in  time 
to  allow  the  second  set  ample  space  for  proper 
growth. 

THRUSH  (WHITE  MOUTH). 

A  parasitic  affection  of  the  mouth  in  infancy. 
The  mouth  is  hot  and  a  number  of  small  white 
patches  appear  on  the  gums  and  soft  palate. 
The  digestion  is  impaired,  and  there  is  slight 
fever.     The  child  will  not  eat  on  account  of  pain. 

Treatment:  Wash  the  mouth  carefully  with  a 
solution  of  Boric  acid  several  times  a  day;  give 
small  doses  of  castor  oil. 


PRACTICE  or  MEDICINE.  X39 

TONSILLITIS. 

Inflammation  of  the  tonsils.  The  tonsils  are 
red  and  swollen;  there  is  pain,  extending  to  the 
ear  and  jaw,  with  difficulty  in  swallowing;  often 
considerable  inflammation  of  the  throat,  and  in 
some  cases  membranes  and  abscesses  may  form ; 
it  is  difficult  to  open  the  mouth  because  of  the 
pain  and  swelling;  chills  and  fever,  accompanied 
by  pain  along  the  spine  and  legs.  Diphtheria 
may  be  confused  with  tonsillitis,  but  the  mem- 
brane in  diphtheria  is  removed  with  difficulty, 
leaving  a  bleeding  surface;  in  tonsillitis  it  is  easily 
removed,  leaving  a  clean  surface;  tonsillitis  is 
often  produced  by  exposure  to  cold.  Suppura- 
tive tonsillitis  (quinsy)  is  due  to  pus  microbes. 

Treatment:  Two  tablespoonfuls  of  Epsom  salts 
should  be  given  at  once.  Warm  or  hot  gargles 
of  Boric  acid  or  Hydrogen  Peroxide  may  be 
used  every  half  hour.  Apply  externally  hot 
poultices,  which  should  extend  well  under  the 
ears.  Give  2  tablets  of  Salol  and  Phenacetin 
every  3  or  4  hours.  An  excellent  gargle  con- 
sists of  Tincture  of  Iron  Chloride  1  teaspoonful, 
and  glycerine  4  teaspoonfuls,  with  4  ounces  of 
water. 


140  MEDICAL  HANDBOOK. 

TOOTHACHE. 

Toothache  in  the  majority  of  cases  is  due 
to  caries  of  a  tooth.  This  decay  may  be  due 
to  bacteria  which  find  a  suitable  soil  in  the 
particles  of  food  accumulated  between  the 
teeth,  if  they  are  not  carefully  and  regularly 
cleaned  after  eating. 

Treatment:  If  there  is  an  accessible  cavity, 
a  small  piece  of  cotton  dipped  in  toothache 
drops  (or  oil  of  cloves,  peppermint,  etc.)  should 
be  introduced  into  it.  Considerable  relief  is 
sometimes  obtained  by  holding  in  the  mouth 
a  solution  of  Bicarbonate  of  Soda  as  hot  as 
can  be  borne.  If  a  gum  abscess  forms  it 
should  be  lanced  without  delay  with  a  previously 
sterilized  knife.  If  decay  is  extensive  the 
tooth  should  be  extracted. 

TUBERCULOSIS  (CONSUMPTION). 

Tuberculosis  is  the  principal  disease  which 
the  native  of  Alaska  has  to  combat;  if  not 
conquered,  it  will  in  time  exterminate  the  race. 
It  is  therefore  important  that  every  one  inter- 
ested in  the  welfare  of  these  people  should  have 
a  thorough  understanding  of  the  cause,  pre- 
vention, and  treatment  of  this  disease.  When 
speaking  of  tuberculosis  we  usually  mean  con- 


PRACTICE  or  MEDICINE.  141 

sumption  of  the  lung,  but  we  must  not  forget 
that  there  are  other  forms  of  this  disease. 
The  tubercle  bacillus  may  attack  the  bones, 
joints,  glands,  skin,  kidneys,  intestines,  throat, 
or  even  the  brain  and  spinal  cord. 

Causes:  The  predisposing  causes  of  tubercu- 
losis are  inherited  weakness,  frequent  exposure 
to  cold  without  sufficient  protection  of  the 
body,  wet  feet,  overcrowded  and  poorly  ven- 
tilated houses,  general  debility,  the  excessive 
use  of  tobacco  and  alcohol,  adenoids,  and  in 
fact  any  condition  which  tends  to  lower  the 
resisting  power  of  the  individual.  Pneumonia 
especially  predisposes  one  to  tuberculosis. 

The  active  cause  is  the  tubercle  bacillus. 
This  is  the  seed  of  the  disease;  it  resembles  a 
small  rod,  which  can  be  detected  only  by  a  mi- 
croscope of  high  power.  The  tubercle  bacillus 
is  not  a  parasite,  but  belongs  to  the  lowest  type 
of  plant  life,  consisting  of  a  single  cell.  For  its 
multiplication  and  activity  a  favorable  soil  and 
nourishment  are  necessary.  Filth,  dirt,  mois- 
ture, and  darkness  fulfill  these  requirements. 
Dryness  and  sunshine  destroy  it.  The  action 
of  the  bacillus,  after  it  has  found  a  suitable 
spot  and  has  increased  in  numbers,  is  a  process 
of  destruction.    The  portion  of  the  lung  at- 


142  MEDICAL  HANDBOOK. 

tacked  is  first  solidified;  this  is  followed  by 
degeneration,  with  the  formation  of  cavities  and 
the  expulsion  of  the  debris  with  the  sputum. 

Mode  of  transmission:  The  tubercle  bacillus 
occurs  in  the  sputum  of  tuberculous  persons, 
and  is  in  the  air  almost  everjnvhere.  It  is  dan- 
gerous to  live  in  a  room  with  a  consumptive. 
With  every  cough  hundreds  of  these  germs  are 
expelled  into  the  air,  unless  a  handkerchief  is 
held  before  the  mouth  during  every  coughing 
spell;  this  is  known  as  '' droplet  infection." 
The  sputum  of  such  a  person  contains  the  seed 
of  the  disease  in  great  numbers.  If  this  sputum 
is  not  collected  and  destroyed  properly,  but  is 
allowed  to  dry  and  to  be  scattered  by  the  wind, 
the  disease  may  be  Avidely  disseminated.  It  is 
therefore  evident  that  we  are  in  constant  dan- 
ger of  infection,  and  it  is  practically  a  case  of 
the  survival  of  the  fittest.  If  our  resistive 
power  is  normal,  we  do  not  contract  the  disease, 
for  the  soil  is  not  favorable;  on  the  other  hand, 
if  our  resistive  power  is  lowered  and  if  we  live 
in  unhygienic  surroundings,  the  soil  is  adapted 
to  the  growth  of  the  germ,  and  infection  is 
likely  to  result. 

The  common  drinking  cup  plays  a  very  im- 
portant factor  in  the  transmission  of  tubercu- 


PRACTICE  OF  MEDICINE.  143 

losis.  Another  cause  which  is  very  prevalent 
among  the  natives  is  the  common  practice  of 
the  mother  chewing  food  for  her  child  to  swal- 
low; the  danger  of  transmitting  tuberculosis 
from  a  consumptive  mother  to  a  healthy  child 
in  this  way  is  obvious.  The  idea  that  tubercu- 
losis is  inherited  is  erroneous,  for  no  one  is  born 
with  the  disease,  but  the  inherited  tendency  or 
predisposition  to  the  disease  can  not  be  denied. 

It  is  of  the  utmost  importance  that  all  cases 
of  tuberculosis  should  be  detected  in  the  early 
stages,  but  unfortunately  this  is  possible  only 
after  a  careful  examination  of  the  chest  by  a 
competent  physician.  It  requires  no  skill  to 
make  the  diagnosis  in  the  later  stages  when 
emaciation,  cough,  fever,  loss  of  weight  and 
pains  in  the  chest  are  present. 

Symptoms:  The  earliest  symptoms  of  con- 
sumption are  a  tired  feeling  after  the  least  exer- 
tion, afternoon  rise  of  temperature,  irregular 
appetite,  and  a  dry,  hacking  cough,  most  notice- 
able in  the  mornings.  As  the  disease  progresses, 
these  symptoms  become  more  marked  and  in 
addition  there  is  anemia,  loss  of  weight  and 
strength,  night  sweats;  the  cough  is  more  con- 
stant, with  expectoration  and  shortness  of 
breath.     In  the  last  stages,  that  of  cavity  for- 


144  MEDICAL  HANDBOOK. 

mation,  the  sputum  is  increased  in  quantity, 
greenish  in  color,  and  may  have  a  foul  odor. 
This  is  also  the  stage  in  which  hemorrhages  are 
frequent.  The  patient  becomes  bedridden;  does 
not  care  for  food ;  may  have  constipation.  Death 
results  from  debility,  rarely  from  hemorrhage. 
A  characteristic  feature  of  this  disease  is  the 
hopeful  attitude  of  the  patient  even  to  the  last 
day. 

Prevention:  This  is  the  keynote  to  the  success- 
ful campaign  against  tuberculosis.  The  con- 
sumptive should  be  isolated  when  possible,  and 
it  is  especially  important  that  he  should  sleep 
alone.  He  should  be  supplied  with  a  proper 
receptacle  for  the  sputum.  The  spit  cup  should 
at  all  times  contain  a  solution  of  carbolic  acid 
and  be  supplied  with  a  cover  to  prevent  flies 
from  carrying  the  germs;  the  cup  should  be 
emptied  and  the  sputum  burned  twice  a  day  or 
oftener  if  necessary.  When  a  special  sputum 
cup  is  not  provided,  the  use  of  any  cuspidor  or 
even  a  tin  can  is  better  than  expectorating  on 
the  floor  and  over  the  bedclothing.  The  patient 
should  have  his  own  dishes,  and  they  should  be 
sterilized  by  boiling  after  each  meal.  Caution 
the  family  against  the  danger  of  kissing,  and 
give  instructions  regarding  ventilation  of  the 


PRACTICE  OF  MEDICINE,  140 

Toom  and  especially  regarding  the  collection 
and  disposal  of  the  sputum. 

After  the  death  of  the  patient  his  clothes  ^nd 
bedclothing  should  be  burned.  His  room  should 
be  sealed  as  tightly  as  possible  and  disinfected 
by  burning  sulphur,  using  10  pounds  of  sulphur 
to  every  1,000  cubic  feet  of  space. 

In  the  schoolroom  pupils  should  receive  sim- 
ple lectures  on  prevention  of  tuberculosis  once 
a  week,  and  signs  bearing  the  inscription  ^'Do 
not  spit  on  the  floor;  to  do  so  naay  spread  con- 
sumption" should  be  posted  in  conspicuous 
places.  The  daily  reading  of  this  rule  by  the 
entire  school  is  sure  to  leave  an  impression, 
Several  spit  cups  with  the  carbolic  solution 
should  be  prepared  and  placed  in  various  parts 
of  the  room  for  those  pupils  who  may  cough 
during  the  session  of  the  school.  Each  day  a 
different  pupil  should  have  charge  of  the  dis- 
posal of  their  contents,  under  the  supervision  of 
the  teacher.  Pupils  should  be  instructed  in  the 
danger  of  placing  pencils,  marbles,  etc.,  in  their 
mouths,  and  especially  cautioned  against  the 
exchange  of  chewing  gum  and  candy.  Twice 
daily  all  the  windows  in  the  schoolroom  should 
be  opened;  the  pupils  should  then  be  required 

TyOS?"— 13 ID 


146  MEDICAL,  HANDBOOK. 

to  rise  in  their  places  and  take  a  series  of  breath- 
ing exercises  lasting  5  minutes.  For  drinking 
purposes  cups  made  in  school  of  stiff  paper 
should  be  used. 

Sleeping  with  open  windows  should  be  con- 
tinually urged  in  the  villages.  The  natives 
should  be  taught  that  the  common  habit  of  re- 
maining in  wet  clothing  or  shoes  is  the  stepping 
stone  to  serious  trouble.  The  effect  of  outdoor 
life  is  plainly  seen  in  the  condition  in  which  the 
natives  return  to  their  villages  after  a  summer 
camping  season.  Many  persons  suffering  from 
tuberculosis  are  alive  to-day  because  of  this 
yearly  outing. 

Adenoids,  if  present,  should  be  removed,  and 
any  obstruction  in  the  nose  should  be  corrected. 
The  general  tone  of  the  system  should  be  im- 
proved if  possible. 

Treatment:  There  is  no  specific  for  tubercu- 
losis. Drugs  have  a  tendency  to  upset  an 
already  delicate  stomach  and  should  be  used 
only  in  special  cases,  in  small  doses,  and  should 
be  discontinued  as  soon  as  possible.  In  brief, 
the  treatment  should  be  plenty  of  fresh  air  and 
sunshine,  moderate  exercise  (walking)  when  pos- 
sible; good,  nourishing  food,  as  milk,  eggs,  clams, 
and  game.     Fatty  foods  are  very  beneficial  and 


PRACTICE  OF  MEDICINE.  147 

should  be  given  freely  when  the  stomach  will 
tolerate  them;  cod  liver  and  seal  oils  are  excel- 
lent foods. 

The  medicinal  treatment  should  be  directed  to 
the  symptoms  as  they  appear.  For  the  weak- 
ness, loss  of  appetite,  and  anemia,  Elixir  of 
iron,  quinine,  and  strychnine,  1  teaspoonful 
before  meals,  is  indispensable.  When  cough  is 
not  excessive,  it  should  not  be  interfered  with, 
for  it  is  nature's  method  of  relieving  the  air 
passages  of  accummulated  secretions.  Creosote 
in  3-grain  doses  every  4  hours  acts  very  well  in 
mild  cases  and  should  be  tried  first.  In  severe 
cough,  where  the  patient  is  unable  to  sleep,  and 
especially  if  it  is  associated  with  pleuritic  pain, 
give  J  teaspoonful  of  Elixir  Terpin  Hydrate 
every  3  or  4  hours ;  for  children.  Brown  Mixture 
is  preferable.  Dose,  |  to  1  teaspoonful  every  3 
or  4  hours  as  required.  Treat  hemorrhage  and 
pleurisy  as  indicated  under  these  headings.  For 
diarrhea  give  Bismuth  Subnitrate,  15  to  20 
grains  eveiy  4  hours. 

TUBERCULOSIS  OF  THE  SPINE. 

This  is  quite  common  among  the  natives  and 
occurs  in  children.  If  allowed  to  remain  un- 
treated, the  results  are  curvature  of  the  spine 


148  Wm>lQAh  HANPPOOi;. 

and  sometimes  paralysis  of  the  lower  limbs,  due 
to  pressure  on  the  cord  and  the  consequent 
degeneration  of  the  nerves  that  supply  the 
lower  extremities. 

Treatment :  It  is  also  important  that  this 
condition  should  be  recognized  in  the  early 
stages.  In  addition  to  the  general  treatment 
for  tuberculosis,  a  support  should  be  applied  to 
the  back,  in  the  form  of  a  plaster  of  Paris  cast. 
This  should  always  be  performed  by  a  physician, 
and  therefore  every  case  should  be  referred  to 
him;  in  the  meantime  the  child  should  be  kept 
in  bed,  at  perfect  rest. 

TDBERCULOSIS  OF  THE  GLANDS. 

This  disease  is  of  common  occurrence  among 
the  natives,  and  the  glands  attacked  are  usually 
those  of  the  neck.  If  allowed  to  progress,  they 
will  suppurate  and  leave  a  discharging  ulcer 
which  leaves  a  scar. 

Treatment :  Treat  on  general  lines  of  tuber- 
culosis or  scrofula.  When  the  glands  suppurate, 
the  patient  should  be  referred  to  a  surgeon. 

TYPHOID  FEVER  (ENTERIC  FEVER). 

Typhoid  fever  is  an  infectious  disease,  due  to 
the  typhoid  bacillus.  Discharges  from  typhoid- 
fever  patients  contaminate  the  drinking  water. 


PRACTICE  OF  MEDICINE.  149 

milk,  shellfish,  or  vegetables.  Typhoid  germs 
are  often  carried  by  flies  to  the  food.  The 
typhoid  bacillus  can  live  for  months  in  water  and 
soil.    The  disease  is  fortunately  rare  in  Alaska. 

Symptoms:  The  disease  begins  with  headache, 
nosebleeding,  coated  tongue,  and  fever.  The 
temperature  is  very  characteristic;  during  the 
first  week  it  rises  continually  until  it  reaches 
104°  F.  During  the  second  week  it  usually 
reaches  its  greatest  height  and  then  gradually 
declines  to  normal.  The  characteristic  typhoid 
temperature  is  always  several  degrees  higher  in 
the  evening  than  in  the  morning  of  the  same  day. 
Diarrhea  is  one  of  the  prominent  symptoms;  the 
stools  are  green  and  resemble  pea  soup.  The 
abdomen  is  distended  by  gas  and  is  sensitive  to 
pressure.  Rose-colored  spots  appear  on  the  ab- 
domen the  seventh  day;  they  disappear  on  pres- 
sure. Delirium  and  various  nervous  symptoms 
are  sometimes  present,  due  to  the  toxins  and 
high  fever.  There  may  be  temporary  insanity. 
A  sudden  drop  of  temperature  indicates  intes- 
tinal hemorrhage  or  perforation. 

Treatment:  Stools  should  be  disinfected  by 
mixing  with  chloride  of  lime;  all  bed  and  per- 
sonal clothing  should  be  boiled  to  prevent  the 
spread  of  the  disease.    After  handling  the  patient 


150  MEDICAIi  HANDBOOK. 

the  hands  should  be  washed  and  then  immersed 
in  Bichloride  of  Mercury  solution,  1  to  1,000. 
Typhoid  fever  is  uninfluenced  by  any  remedy, 
and  its  course  can  not  be  shortened. 

The  patient  ought  to  be  removed  to  a  hospital 
at  once  and  restricted  to  a  diet  of  milk  and  beef 
tea,  given  at  regular  intervals  of  3  hours  during 
both  night  and  day.  Give  1  grain  of  calomel. 
Cold  water  may  be  given  freely  to  allay  thirst. 
If  the  tongue  becomes  dry  and  brown  and  the 
abdomen  distended,  give  5  drops  of  spirits  of 
turpentine  in  water  every  4  hours.  Control  fever 
by  sponging  with  ice  water  when  over  103°  F. 
Wash  the  mouth  and  teeth  often.  If  the  patient 
seems  to  be  weak  give  Strychnine,  go  of  a  grain 
3  times  a  day.  If  intestinal  hemorrhage  occurs, 
put  an  ice  bag  on  the  abdomen,  raise  the  foot  of 
the  bed,  remove  the  pillow  entirely,  and  give 
Morphine,  J  of  a  grain,  at  once. 

ULCERS. 

Ulcers  of  the  skin  are  usually  found  on  the 
lower  extremities.  Varicose  veins  are  a  com- 
mon cause .  Wounds,  abscesses,  frostbites,  burns, 
and  bruises  usually  terminate  in  acute  ulcera- 
tions which  if  not  properly  treated  are  liable 
to  become  chronic.     Uncured  cases  of  syphilis 


PRACTICE  OF  MEDICINE.  151 

have  a  tendency  to  cause  ulcerations  on  differ- 
ent parts  of  the  body. 

Bed  sores  are  caused  by  pressure,  from  lying 
or  sitting  in  bed  for  a  long  time,  as  in  paralysis 
or  during  the  course  of  a  severe  illness.  These 
ulcerations  usually  occur  on  the  shoulders, 
buttocks,  hips,  heels,  or  even  ankles.  While 
pressure  is  the  direct  cause,  infrequent  bathing 
of  the  parts,  and  uncleanliness  due  to  perspira- 
tion, urine,  faeces,  and  unclean  clothing  on  the 
person  or  the  bed  predispose  to  their  appearance. 
Eczema  has  a  tendency  to  sloughing,  which  pro- 
duces ulcers  on  the  neck,  body,  legs,  etc. 

Ulcers  are  as  a  rule  tender  and  inflamed 
and  have  generally  a  hard  elevated  area  around 
the  edges.  The  acute  ulcer  is  usually  rapid  in 
its  progress  and  severity,  and  is  always  accom- 
panied by  pain  of  a  throbbing  and  stinging 
character;  chronic  ulcerations  are  usually  smaller 
and  the  inflammation  less  severe.  Chronic 
ulcers  may  remain  stationary  for  a  long  time, 
and  then  without  apparent  cause  suddenly 
begin  to  slough  and  in  some  cases  may  pene- 
trate to  the  bone. 

Treatment:  In  treating  ulcers  caused  by  bed 
sores,  a  careful  adjustment  of  pressure  on  all 
parts  of  the  body  by  the  use  of  a  good  mattress 


152  Medical  handbook. 

is  essential.  Frequent  changes  of  the  patient's 
position  are  necessary.  The  body  should  be 
freq[uently  bathed  and  the  skin  hardened  by 
Sponging  with  alcohol  to  which  a  little  alum  or 
spirits  of  camphor  has  been  added;  the  skin 
should  then  be  carefully  dried  and  afterwards 
dusted  with  Talcum  powder. 

Varicose  ulcers  are  best  treated  by  placing  the 
patient  in  bed  and  elevating  the  limb.  The 
ulcer  should  be  first  washed  with  Boric  acid  solu- 
tion; and  then  it  should  be  dusted  with  Bismuth 
or  Idodoform,  if  the  ulcer  is  small,  a  light  dress- 
ing of  clean  cheesecloth,  cotton,  and  bandages 
should  be  applied.  If  for  any  reason  it  is  impos- 
sible for  the  patient  to  go  to  bed,  the  varicose 
veins  should  be  supported  by  an  elastic  stock- 
ing or  bandage. 

General  considerations:  Wash  all  ulcers  thor- 
oughly with  Boric  acid  solution.  If  there  is  a 
large  amount  of  pus,  use  Peroxide  Hydrogen. 
Always  dry  the  ulcers  by  gently  touching  with 
cotton.  Powder  with  Boric  acid  or  Iodoform. 
Cover  ulcers  with  5  or  6  layers  of  antiseptic 
gauze.  The  bandage  must  not  be  too  tight,  61* 
it  will  obstruct  the  circulation.  Secure  the 
bandage  with  strips  of  adhesive  plaster  or  safety 
pins.     In  dressing  ulcers,  cleanliness  is  of  the 


PKAGTICE  Of  MEDICINE.  153 

Titmost  importance.  Avoid  contact  with  pus, 
as  it  is  often  contagious ;  never  forget  to  wash  the 
hands  thoroughly  after  touching  ulcers  or  wounds 
of  any  kind. 

ULCER  OF  THE  STOMACH. 

Ulceration  of  the  stomach  is  caused  by  ab- 
normal acidity  or  indiscretion  in  food,  alcohol, 
etc. 

Symptoms:  Indigestion  and  loss  of  weight; 
hyperacidity;  constant  pain  in  the  pit  of  the 
stomach,  which  is  increased  by  taking  food; 
vomiting  soon  after  eating;  the  vomited  matter 
is  mixed  with  red  blood.  The  disease  occurs  in 
young  adults,  and  is  liable  to  terminate  in  per- 
foration of  the  stomach  and  death. 

Treatment. — Diet  of  milk,  eggs,  and  light 
foods,  excluding  meats,  etc.;  perfect  rest  in  bed; 
give  Bismuth  Subnitrate,  20  grains  every  3 
hoiirs,  and  1  teaspoonful  of  Soda  Bicarbonate 
in  half  a  glass  of  water  1  hour  after  meals;  regu- 
late the  bowels;  for  severe  pain  J  grain  of  mor- 
phine. 

VACCINATION. 

(See  Smallpox.) 

VOMITING. 

Vomiting  is  only  a  symptom  of  some  morbid 
process  and  may  occur  in  the  course  of  any 
disease. 


154  MEDICAL  HANDBOOK. 

Vomiting  due  to  catarrh  of  the  stomach  is  easily 
recognized,  as  the  vomiting  invariably  follows 
the  introduction  of  food  into  the  stomach.  For 
treatment,  give  Bismuth  Subnitrate,  15  grains 
after  meals. 

Vomiting  due  to  acute  inflammation  of  the 
stomach  is  associated  with  pain,  eructations  of 
gas,  and  constant  nausea.  The  pain  as  a  rule 
is  relieved  by  the  act  of  vomiting,  and  is  in- 
creased by  taking  food.  The  tongue  is  usually 
furred,  and  in  some  cases  a  red  line  on  the  gums 
occurs.     There  is  absolute  aversion  to  food. 

Give  Bismuth  Subnitrate,  15  grains  after 
meals. 

Vomiting  caused  by  ulceration  of  the  stomach 
has  identically  the  same  symptoms  as  the  former, 
but  there  is  blood  in  the  vomited  matter,  and 
pain  and  tenderness  over  the  stomach  when 
pressure  is  applied.     {See  Ulcer  of  stomach.) 

Toxic  vomiting  may  occur  at  any  time.  The 
most  prominent  symptoms  are  distention  of  the 
stomach  and  formation  of  gas  from  decomposi- 
tion. The  vomit  is  profuse  and  gelatinous. 
Give  calomel,  J  grain  every  hour  till  bowels  move 
freely,  followed  by  Epsom  salts. 

Vomiting  due  to  constipation  is  accompanied 
by  a  coated  tongue,  bad  taste  in  the  mouth. 


PRACTICE  OF  MEDICINE,  155 

fainting,  and  despondency.  A  good  cathartic 
is  needed. 

Nervous  vomiting  is  due  to  a  variety  of  nerve 
diseases  which  act  on  the  vomiting  center  in  the 
brain.  This  type  occurs  without  nausea  and 
without  reference  to  the  character  of  the  food. 
The  attacks  are  usually  accompanied  by  severe 
headache. 

Vomiting  from  cancer  of  the  stomach:  The  vom- 
ited matter  has  coffee-ground  appearance  and  is 
accompanied  by  attacks  of  faintness.  Give 
Morphine,  J  of  a  grain  3  times  a  day. 

WHOOPING  COUGH. 

As  whooping  cough  is  highly  contagious  and 
often  fatal  to  infants,  strict  quarantine  should  be 
enforced.  It  commences  as  acute  catarrh  of  the 
bronchial  tubes,  and  in  several  days  reaches  the 
whooping  stage.  There  are  spasmodic  attacks 
of  coughing,  which  occur  with  varying  fre- 
quency .  The  paroxysms  are  sudden  and  violent, 
and  the  patient  seems  to  be  on  the  verge  of  suf- 
focating. A  quantity  of  mucus  may  be  coughed 
up,  instantly  relieving  the  coughing.  Coughing 
often  produces  vomiting  and  sometimes  rupture. 
This  disease  may  last  from  1  to  6  months,  and  is 
sometimes  followed  by  tuberculosis. 


156  MEDICAL,  HANDBOOK. 

Treatment:  Because  of  vomiting,  give  food  in 
small  quantities  and  at  frequent  intervals,  in 
order  to  secure  the  retention  of  sufficient  nourish- 
ment. Diminish  the  severity  of  the  paroxysms 
by  giving  Bromide  of  Potash,  5  grains,  with 
Tincture  opium  camphorated  5  drops,  3  or  4 
times  a  day. 

women's  diseases. 

amenorrhea   (suppression   of  the   monthly 
flow). 

Suppression  of  the  menstrual  flow  is  normal 
only  during  pregnancy  and  lactation,  or  after  the 
age  of  45,  when  it  usually  ceases  completely; 
otherwise  it  is  pathological.  Acute  fevers,  over- 
work, insufficient  food,  emotional  disturbances, 
such  as  anger,  fear,  anxiety,  or  grief,  may  cause 
a  temporary  cessation  of  the  menses  or  a  decrease 
in  the  flow;  an  ordinary  cold  also  may  cause 
suppression.  In  anemia  and  tuberculosis  the 
flow  may  cease  entirely;  this  should  be  regarded 
simply  as  a  wise  provision  of  nature  to  prevent 
any  further  drain  or  loss  to  an  already  depleted 
system. 

Accompanying  symptoms:  In  the  great  majority 
of  cases  there  is  a  sensation  of  weight  in  the 
abdomen,  with  nervousness,  headache,  flashes  of 


PRACTICE  or  MEDICINE.  157 

heat  and  cold,  slight  fever,  and  general  depres- 
sion; there  is  a  tendency  to  hysteria. 

Treatment:  This  condition  should  not  be  inter- 
fered with,  as  in  the  majority  of  cases  it  is  only 
temporary,  and,  although  it  has  a  depressing 
effect  on  the  patient,  it  does  no  material  harm. 
If  due  to  cold,  it  may  usually  be  relieved  by 
rest  in  bed,  hot  foot  baths,  and  saline  laxatives. 
In  anejnic  cases  Elixir  iron,  quinine,  and  strych- 
nine, 1  teaspoonful  before  meals  is  beneficial. 

DYSMENORRHEA. 

Painful  menstruation  is  due  to  heredity  and  a 
predisposition  to  hysteria.  It  may  be  caused 
temporarily  by  overwork.  Inflammation  of  the 
uterus  or  tubes  and  displacement  or  falling  of 
the  womb  are  comimon  causes. 

Symptoms:  The  most  pronounced  symptom 
is  severe  pain,  which  may  begin  several  days 
before  the  menstrual  period.  The  discharge  is 
dark  colored  and  clotted. 

Treatment:  Hot  mustard  footbath,  hot-water 
bottle,  or  turpentine  stupes  to  the  abdomen; 
small  doses  of  Epsom  salts  every  day;  1  tea- 
spoonful  of  Fluid  Extract  of  Viburnum  Com- 
pound every  4  hours;  light  diet  and  rest  in  bed 
are  essential.  Some  cases  are  relieved  only  by 
an  operation. 


158  MEDICAL  HANDBOOK. 

MENORRHAGIA. 

Profuse  menstruation  is  usually  due  to  con- 
gestion of  the  uterus  or  ovaries  or  to  displace- 
ment. If  due  to  injuries  of  the  womb,  tumors, 
or  cancer,  it  is  not  only  profuse  but  the  intervals 
between  the  menstrual  periods  are  shorter. 

Treatment:  To  relieve  the  hemorrhage  give  15 
drops  of  Fluid  Extract  of  Ergot  combined  with 
1  teaspoonful  Fluid  Extract  Viburnum  Com- 
pound every  3  or  4  hours ;  absolute  rest  and  mild 
laxatives. 

INFLAMMATION    OF   THE    OVARIES. 

This  is  not  a  disease,  but  a  symptom  which 
accompanies  the  majority  of  pelvic  disturbances. 

Treatment:  Hot  applications;  cathartics;  rest 
in  bed;  5  grains  of  Dovers  powder  every  4  hours. 
The  same  treatment  will  apply  to  inflammation 
of  the  womb. 

LEUCORRHEA  (WHITES). 

This  is  a  symptom  of  many  diseases  of  the 
female  sexual  organs.  It  may  be  due  to  local 
infection  or  to  pelvic  congestion  caused  by  con- 
stipation, pregnancy,  or  displacement  of  the 
womb.     It   frequently   occurs   in   anemic    and 


PRACTICE   or    MEDICINE.  159 

consumptive  women  and  is  very  general  in 
northern  climates.  This  discharge  is  not  con- 
tagious and  should  not  be  confused  with 
gonorrhea. 

Symptoms:  White  mucous  discharge;  there 
may  be  irritability  of  the  bladder. 

Treatment:  Good  food,  open-air  exercise,  and 
mild  laxatives.  Use  douches  of  hot  water,  con- 
taining vaginal  antiseptic  tablets,  morning  and 
night. 

GONORRHEA. 

In  females,  as  in  males,  it  is  due  to  a  specific 
germ  and  i.s  generally  contracted  through  sexual 
intercourse.  The  differential  diagnosis  between 
this  disease  and  leucorrhea  can  be  determined 
positively  only  by  a  microscopical  examination 
of  the  discharge. 

Symptoms:  The  first  symptoms,  which  occur 
from  4  to  10  days  after  infection,  are  heat,  red- 
ness, and  swelling  of  the  parts.  A  watery  dis- 
charge then  appears,  which  in  a  few  days  devel- 
ops into  a  profuse,  thick,  creamy  one.  There  is 
frequent  painful  urination,  with  a  burning  sen- 
sation. The  discharge  gradually  diminishes, 
and  the  disease  may  become  chronic.  This  dis- 
ease may  extend  to  the  uterus  and  tubes. 


160  MEDICAL  HANDBOOK. 

Treatment:  Rest  in  bed,  light  diet,  open 
bowels,  plenty  of  water  to  drink.  The  patient 
should  be  instructed  regarding  the  contagious 
character  of  the  discharge  and  cautioned  not  to 
infect  the  eyes  with  it.  Locally,  use  vaginal 
antiseptic  tablets  dissolved  in  a  quart  of  hot 
water  as  a  douche  3  or  4  times  a  day.  Gonor- 
rhea can  be  properly  treated  only  by  a  physi- 
cian and  in  a  hospital. 

SUMMARY. 

In  all  diseases  of  the  pelvis  use  Epsom  salts 
liberally.  Where  discharges  occur,  hot  vaginal 
douches  are  required.  The  pain  in  most  cases 
may  be  relieved  by  hot  footbaths,  hot  applica- 
tions over  the  abdomen,  and  the  administration 
of  small  doses  of  Dover's  powder  or  Phenacetin. 

Never  interfere  with  suppression  of  menses  in 
any  manner  except  that  recommended  here. 

Patients  afflicted  with  excessive  flow  should 
be  referred  to  a  physician  at  the  first  opportunity. 

Do  not  forget  that  in  all  inflammations  of  the 
pelvis,  perfect  rest  is  of  the  utmost  importance. 
Vaginal  discharges  are  apt  to  be  contagious; 
therefore  warn  the  patient  accordingly. 

Backache,  hysteria,  disturbances  of  the  stom- 
ach, and  irritation  of  the  bladder  may  accom- 
pany any  or  all  of  the  above  disorders. 


PKACTICE   OF    MEDICINE.  161 

WORMS,  INTESTINAL. 

There  is  but  one  symptom  that  positively 
proves  that  a  person  has  intestinal  worms, 
namely,  worms  or  parts  of  worms  found  in  the 
stools. 

Tapeworm:  The  segments  of  tapeworms  are 
flat,  about  three  quarters  of  an  inch  in  length  and 
hinged  together  like  scales  of  armor  in  a  con- 
tinuous chain,  which  may  reach  a  length  of  from 
20  to  40  feet.  Tapeworm  is  of  a  transparent 
grayish  color. 

Round  worms  occur  mostly  in  children.  They 
are  from  5  to  6  inches  in  length  and  resemble  in 
appearance  a  common  earthworm. 

Pinworms  are  about  one-tenth  of  an  inch  long. 
They  are  usually  found  around  the  rectum  and 
are  associated  with  a  disagreeable  sensation  of 
itching  and  burning. 

Treatment  for  round  or  tape  worm:  Give  no 
food,  either  liquid  or  solid,  for  a  period  of  6 
hours;  then  administer  calomel  J  grain  every 
hour  for  4  hours,  and  follow  with  1  tablespoonful 
of  Epsom  salts.  If  the  worm  or  segments  should 
be  found  in  the  feces,  send  it  to  the  nearest 
physician  for  identification. 

77037°— 13 11 


162  MEDICAL  HANDBOOK. 

For  pinworms  give  a  large  enema  of  Epsom 
salts  and  water. 

WOUNDS. 

Wounds  may  be  produced  by  sharp  or  blunt 
instruments,  violence,  bullets,  etc.  The  symp- 
toms are  laceration,  hemorrhage,  and  pain.  The 
amount  of  the  hemorrhage  depends  on  the  size 
and  condition  of  the  severed  blood  vessel,  in 
addition  to  the  extent  of  the  wound.  If  a  bullet 
penetrates  the  flesh  and  fractures  a  bone,  the 
pain  is  usually  intense.  In  wounds  of  the 
abdomen,  chest,  and  pelvis,  the  hemorrhage  is 
usually  internal. 

Treatment:  Before  undertaking  the  dressing  of 
any  wound,  or  stopping  hemorrhage,  the  hands 
should  be  thoroughly  washed  in  Bichloride  of 
Mercury  solution  1  to  1,000.  All  instruments, 
needles,  and  sutures  must  be  sterilized  by  boiling 
for  15  minutes,  or  if  this  is  not  practicable  place 
them  in  a  10  per  cent  carbolic-acid  solution  for  10 
minutes,  and  afterwards  rinse  with  grain  alcohol. 
If  the  wound  is  not  bleeding  profusely,  wash 
thoroughly  with  a  solution  of  Bichloride  of 
Mercury,  1  to  4,000,  and  arrest  the  hemorrhage 
as  quic^y  as  possible.  If  the  hemorrhage  is  not 
severe,  continued  firm  pressure  over  the  surface 
of  the  wound  with  a  pad  of  absorbent  cotton  or 


PKACTICE   OF    MEDICINE.  163 

sterile  gauze  (which  has  been  previously  dipped 
in  a  hot  solution  of  Bichloride  of  Mercury)  will 
usually  stop  it  in  a  short  time. 

Should  the  hemorrhage  be  due  to  the  severing 
of  a  large  vessel,  ligation  becomes  necessary. 
To  ligate,  grasp  the  end  of  the  bleeding  vessel 
with  hemostatic  forceps  and  tie  it  firmly  with 
sterilized  catgut.  When  securely  tied,  cut  the 
ends  of  the  catgut  close  to  the  knot. 

If  the  hemorrhage  is  very  extensive,  applica- 
tion of  a  tourniquet  is  necessary;  the  toarni- 
quet  may  be  improvised  from  a  clean  bandage, 
handkerchief,  etc.  If  the  wound  is  caused  by  a 
sharp  instrument,  the  hemorrhage  is  best  con- 
trolled by  applying  sutures.  The  needle  carry- 
ing the  suture  should  enter  the  skin  at  one  side 
of  the  wound  and  pass  out  through  the  skin  at 
the  other  side;  then  tie  firmly.  Sterilized  cat- 
gut or  silk  is  the  most  appropriate  suture.  When 
the  hemorrhage  has  been  controlled  wash  the 
wound  by  gently  sponging  with  Bichloride  of 
Mercury,  1  to  4,000;  then  apply  a  dressing  of 
several  thicknesses  of  sterilized  gauze,  which 
should  be  kept  in  place  by  a  bandage. 

The  dressing  need  not  be  disturbed  for  2  days; 
then  wash  the  wound  daily  with  Bichloride  of 
Mercury  solution  and   apply  a  fresh  dressing. 


164  MEDICAL.  HANDBOOK. 

The  sutures  should  be  removed  as  soon  as  the 
wound  heals.  As  rest  is  essential  to  the  healing 
of  wounds,  keep  the  injured  member  quiet  and 
in  a  comfortable  position  by  the  use  of  splints, 
bandges,  etc.  If  the  wound  is  severe,  the 
patient  should  be  kept  in  bed.  If  gangrene 
follows,  treat  accordingly. 


CHAPTER  Xn. 

VENTILATION. 


Air  for  the  lungs  is  just  as  essential  as  food 
for  the  stomach ;  we  cannot  live  without  either. 
Foul  or  insufficient  air,  like  bad  or  insufficient 
foodj  interferes  with  the  functions  of  the  human 
mechanism  and  predisposes  one  to  disease. 
Tuberculosis  is  practically  a  disease  due  to  living 
under  unhygienic  conditions — oxygen  starva- 
tion. Patients  in  hospital  wards  which  are  well 
supplied  with  fresh  air  recover  earlier  than  those 
who  are  deprived  of  it. 

The  lungs  are  never  entirely  filled  with  pure 
air  after  the  first  inspiration  following  birth, 
since  they  are  never  wholly  emptied  and  what- 
ever remains  is  vitiated.  The  upper  part  of  the 
respiratory  tract  is  the  only  part  that  receives 
strictly  pure  air.  The  amount  of  oxygen  used 
varies  with  age  and  other  conditions.  During 
work  we  consume  more  oxygen  than  when  at 
rest  or  during  sleep;  more  in  cold  weather  than 
when  it  is  hot,  etc.     Oxygen  is  fuel  for  the  body 

165 


166  MEDICAL.  HANDBOOK. 

just  as  food  is.  On  the  average,  an  adult 
requires  3,000  cubic  feet  of  air  an  hour. 

Normal  air  contains  slightly  more  than  one- 
fifth  oxygen,  the  only  part  of  it  essential  for 
breathing.  The  nitrogen  acts  only  as  a  diluting 
agent.  If  the  amount  of  oxygen  in  a  given 
quantity  of  air  is  reduced  by  one-fifth,  it  becomes 
incapable  of  supporting  life.  Passing  into  the 
lungs,  the  air  there  is  deprived  of  one-fourth  of 
its  oxygen,  carbonic  acid  gas  is  given  to  it  in 
exchange.  The  expired  air,  therefore,  not  only 
can  not  sustain  life,  but  it  actually  vititates  the 
surrounding  air. 

The  normal  amount  of  carbonic  acid  gas  that 
may  be  breathed  constantly  without  objection- 
able results,  is  believed  to  be  about  7  parts  in 
10,000  of  air.  The  more  carbonic  acid  gas 
there  is  in  a  room,  the  more  organic  matter  there 
is  likely  to  be  found,  and  therefore,  the  more 
danger  there  is  of  contagion  being  gathered 
from  the  air. 

There  are  but  few  natives  who  suffer  for  want 
of  food,  but  there  are  many  who  do  suffer  with 
air  starvation  and  its  deleterious  effects.  Ven- 
tilation is  the  necessity  that  is  most  neglected 
by  the  native,  but  still  the  most  vital  to  his 
welfare.     It  is  a  matter  of  prime  importance, 


VENTILATION.  167 

and  should  receive  the  immediate  and  most 
careful  attention  of  teachers. 

Ideal  ventilation  consists  of  supplying  the 
proper  quantity  of  air  without  creating  a  draft 
in  the  room.  In  the  summer,  ventilation  is  a 
very  simple  problem;  it  is  readily  accomplished 
by  opening  windows  and  doors.  Still,  few 
natives  take  advantage  of  the  opportunity. 
Even  during  the  hottest  days  of  the  year  it  is' 
not  uncommon  to  find  their  homes  practically 
sealed,  the  windows  and  doors  closed,  and  the 
rooms  hot  and  unbearable  because  of  the  foul 
air.  This  fault  should  be  remedied,  and  free 
ventilation  urged  in  every  village. 

During  the  winter  months  the  problem  is  more 
difficult.  It  is  often  out  of  the  question  to  allow 
the  doors  to  remain  open,  but  a  window  may 
usually  be  opened  partially  without  discomfort 
to  the  occupants,  and  without  material  loss  of 
heat.  Foul  and  hot  air  rises  and  collects  at  the 
ceiling;  this  furnishes  a  key  to  the  problem. 
Even  with  doors  and  windows  closed,  if  two  or 
three  2-inch  holes  are  bored  in  the  walls  just 
beneath  the  eaves,  a  quantity  of  the  foul  air  and 
the  accompanying  odor  will  escape  without  any 
draft,  and  conditions  within  will  be  greatly  im- 
proved.    A  few  cabins  are  provided  with  a  spe- 


168  MEDICAL  JIANDBOOK. 

cial  air  escape  in  the  roof,  in  the  form  of  a  flume 
about  5  inches  square.  The  outlet  is  covered  to 
prevent  the  rain  and  snow  from  entering  the 
room,  but  openings  are  left  to  permit  the  free 
passage  of  air.  This  is  an  excellent  plan  of  ven- 
tilation, inexpensive  and  simple  in  construction, 
and  it  should  be  introduced  into  every  native 
house. 

It  is  as  important  to  be  supplied  with  fresh  air 
during  sleep  at  night  as  during  the  day.  The 
windows  should  be  left  open,  but  special  care 
should  be  taken  to  have  the  body  well  covered 
and  warm.  The  head  of  course  should  be  un- 
covered. Night  air  is  harmless,  provided  the 
body  is  well  protected.  The  native  usually  has 
a  supply  of  furs  sufficient  for  covering. 

It  is  also  important  to  air  and  sun  the  bed 
clothing  frequently.  For  this  purpose  a  dry  and 
sunny  day  should  be  selected,  and  the  clothes 
should  be  well  spread  to  expose  as  much  of  the 
surface  as  possible  to  the  free  air. 

It  is  the  teacher's  duty  to  see  that  the  school- 
room is  well  ventilated  at  all  times  and  not  too 
hot.  Pupils  can  not  learn  or  retain  their  health 
in  a  stuffy  room;  their  minds  become  dull  and 
they  feel  drowsy. 


VENTII^ATTON.  169 

The  simplest  way  to  keep  the  air  in  a  class- 
room pure  without  creating  a  draft  is  to  open  the 
windows  about  2  inches  from  the  top,  preferably 
on  one  side  only.  During  recess  and  lunch  hour, 
when  the  pupils  are  out  of  the  room,  all  the  win- 
dows should  be  opened  both  top  and  bottom  and 
closed  just  before  school  is  called  again. 

Breathing  exercises,  practiced  for  5  minutes 
once  during  the  morning  session  and  once  in  the 
afternoon,  will  be  found  exceedingly  beneficial. 
The  practice  does  not  consume  much  time,  cre- 
ates new  life  in  the  pupils,  and  incidentally  per- 
mits change  of  air  in  the  room.  The  windows 
should  be  opened,  the  pupils  should  rise,  line  up 
in  the  aisle,  and  go  through  the  exercises  to  the 
count  of  the  teacher.  Details  of  breathing  exer- 
cises may  be  found  in  any  book  on  school  hygiene. 

The  temperature  of  the  schoolroom  should 
never  exceed  70°  F.,  and  the  pupils  should  not 
be  allowed  to  sit  in  school  without  removing  their 
overcoats  or  parkees.  The  sudden  change  from 
a  heated  room  to  the  cold  outdoor  air  without 
proper  protection  is  responsible  for  many  colds. 


CHAPTER  XIII. 
QUARANTINE  AND  DISINFECTION. 


Quarantine  is  a  means  of  preventing  the 
spread  of  contagious  diseases  from  infected  per- 
sons and  localities  to  other  persons  and  places. 
Contagious  diseases  are  communicated  either 
directly  from  the  sick  to  the  well,  or  by  the 
medium  of  some  "carrier."  This  carrier  may 
be  a  person  who  has  been  exposed  to  the  dis- 
ease; though  he  may  not  contract  it  himself  he 
may  carry  the  germs  about  his  person  and  thus 
be  a  menace  wherever  he  goes.  Such  carriers 
are  sometimes  all  the  more  dangerous  because 
they  are  difficult  to  locate,  on  account  of  their 
own  immunity.  Other  carriers  are  infected 
stools,  secretions  from  the  nose  and  throat,  and 
the  towels,  dishes,  and  bedclothing  of  patients. 

The  more  common  diseases  in  which  quaran- 
tine is  necessary  are  smallpox,  measles,  diph- 
theria, scarlet  fever,  chicken  pox,  infantile  par- 
alysis, whooping  cough,  and  mumps. 

When  a  doubt  exists  as  to  whether  a  quaran- 
tine should  be  established,  it  is  better  to  err  on 
the  safe  side  and  to  adopt  all  measures  of  pre- 
caution.   The  earlier  a  case  of  contagious  disease 

170 


QUARANTINE  AND  DISINFECTION.  171 

is  detected  and  quarantined,  the  better  are  the 
prospects  for  checking  the  spread  of  it.  The 
ideal  quarantine  is  not  always  feasible  in  a  na- 
tive village,  unfortunately,  but  we  must  do  the 
best  we  can  under  the  circumstances. 

When  a  case  of  contagious  disease  is  reported, 
if  it  is  impossible  to  call  a  physician,  the  super- 
intendent of  the  district  should  be  notified.  To 
allow  a  contagious  disease  to  rage  without  an 
attempt  to  check  it  is  little  less  than  criminal. 

The  patient  should  be  placed  in  a  separate 
room,  and  no  one  but  the  physician  and  nurse 
should  be  admitted.  Other  persons  who  lived 
in  the  same  room  or  came  in  contact  with  the 
patient  should  be  kept  in  a  separate  room  or 
house  and  carefully  watched  for  symptoms.  If 
the  disease  should  develop  among  the  suspects, 
immediately  isolate  the  new  case  and  treat  it 
precisely  like  the  original  one.  The  house  should 
be  quarantined,  and  notices  posted  at  the  en- 
trance to  warn  people  that  there  is  a  contagious 
disease  within;  thus — 


DANGER,  KEEP  OUT! 
DIPHTHERIA. 


172  MEDICAL  HANDBOOK. 

Guards  should  be  appointed  to  enforce  the 
quarantine. 

Whenever  several  cases  of  the  same  disease 
occur  in  a  village,  it  is  advisable  to  close  the 
school  and  prevent  the  people  from  congregat- 
ing. The  danger  of  the  disease  and  the  results 
of  breaking  quarantine  should  be  fully  explained 
to  the  natives  of  the  village,  and  they  should  be 
assured  that  the  quarantine  is  for  their  personal 
protection.  Under  these  circumstances  it  will 
probably  not  be  difficult  to  check  the  disease, 
and  good  results  may  be  secured  without  the 
services  of  a  police  officer. 

The  isolated  patients  should  have  their  own 
dishesj  and  these  should  not  be  removed  from 
the  room.  Nothing  should  be  taken  from  the 
room  until  it  has  been  thoroughly  disinfected. 

Before  entering  the  sick  room  the  physician 
and  nurse  should  always  wear  a  cap  and  gown. 
If  a  gown  is  not  convenient,  a  sheet  wrapped 
about  the  person  will  answer  the  purpose.  Be- 
fore leaving  the  sick  room  the  cap  and  gown 
should  be  discarded,  the  hands  washed  in  a  1-to- 
1,000  solution  of  Bichloride  of  Mercury,  and  a 
hasty  exit  made.  A  clean  cap  and  gown  should 
be  worn  at  each  visit. 


QUARANTINE  AND  DISINFECTION.    <  173 

All  secretions  should  be  made  antiseptic  before 
disposal.  The  urine  and  stools  should  be  de- 
posited in  a  vessel  containing  a  strong  solution  of 
chloride  of  lime.  The  nasal  and  throat  secre- 
tions should  be  burned.  The  dishes  used  should 
be  sterilized  by  boiling  for  a  half  hour.  Soak 
sheets,  towels,  napkins,  and  blankets  in  a  bi- 
chloride solution  before  washing.  Mattresses 
and  furs  are  difficult  to  disinfect,  and  should  be 
burned. 

After  the  patient  has  recovered,  he  should  dis- 
card all  clothing  in  the  sick  room,  jump  into  a 
bath  tub  in  an  adjoining  room,  and  put  on  clean 
clothes.  The  sick  room  should  then  be  thor- 
oughly disinfected.  Everything  in  it  should  be 
spread  out,  so  that  the  gas  of  the  disinfectant  can 
penetrate  every  portion  of  the  infected  articles. 
Formaldehyde  gas  is  the  ideal  disinfectant,  as  it 
is  efficient  and  does  not  bleach  or  injure  any  of 
the  furnishings,  but  for  a  native  cabin  sulphur 
will  answer  the  purpose  very  well,  and  the 
method  of  application  is  simple. 

First,  it  is  necessary  to  make  the  room  tight, 
or  as  tight  as  possible.  Place  a  large  dishpan  of 
water  in  the  center  of  the  room,  and  into  it  place 
the  vessel  containing  the  sulphur,  in  order  to  pro- 
tect the  house  against  fire.    Select  some  suitable 


174  MEDICAL  HANDBOOK. 

vessel  (a  Dutch  oven  is  best),  put  a  little  kindling 
wood  into  it,  and  place  the  sulphur  rolls  (brim- 
stone) over  the  wood.  Place  the  Dutch  oven  in 
the  dishpan,  and  light  the  kindling.  Leave  the 
room  quickly,  for  the  fumes  are  poisonous.  Close 
the  door  and  place  a  suitable  notice  over  it,  so 
that  it  will  not  be  opened  by  mistake.  The 
room  may  be  opened  after  24  hours  and  allowed 
to  air  thoroughly  before  being  occupied  again. 
Ten  pounds  of  sulphur  should  be  used  for  every 
1,000  cubic  feet  of  space. 

Disinfection  of  native  cabins  is  not  always  sat- 
isfactory, because  it  is  not  always  possible  to  seal 
them  thoroughly,  and  for  this  reason  it  is  better 
and  safer  to  burn  them  if  practicable. 

It  may  be  stated  that  the  disinfection  method 
described  above  is  of  service  for  destroying  fleas, 
flies,  mosquitos,  mice,  and  bedbugs. 


CHAPTER  XIV. 
NATURAL  SELF-PROTECTION. 


In  all  bodies,  both  animal  and  vegetable,  there 
is  a  well-developed  system  of  self-protection.  In 
animals  the  nasal  secretions  are  mildly  anti- 
septic, and  even  the  tears  possess  bactericidal 
properties.  The  characteristic  fluid  produced  by 
one  gland  or  set  of  glands  is  never  produced  by 
another.  The  blood  itself  is  not  only  the  great 
nutritive  fluid  of  the  body,  but  it  carries  different 
ingredients  to  different  glands,  from  which  each 
gland  individually  extracts  the  particles  neces- 
sary in  its  normal  functions.  Even  in  the 
process  of  elimination  of  foreign  bodies  the 
organs  possess  a  power  of  selecting  different 
substances.  The  wandering  cells  of  the  animal 
organism  (the  leucocytes)  possess  the  property 
of  taking  up,  rendering  inert,  and  digesting 
micro-organisms  which  they  encounter  in  the 
blood  and  other  tissues. 

175 


176  MEDICAL  HANDBOOK. 

PROTECTION  BY  IMMUNITY. 

Immunity  may  be  classified  as  follows: 

1.  Natural  immunity. 

2.  Acquired  immunity. 

(a)  By  heredity. 
(h)  By  disease. 

(c)  By  accident. 

(d)  Temporary. 

3.  Artificial  immunity. 

Some  individuals  possess  immunity  to  a 
marked  degi'ee,  while  others  exhibit  only  a  feeble 
resistance  to  bacterial  organism.  Immunity  is 
never  general;  it  does  not  confer  protection 
against  all  contagious  or  infectious  diseases,  but 
only  to  special  diseases,  rendering  a  person 
invulnerable  to  one  or  another. 

Many  animals  are  less  susceptible  to  infection 
than  others.  Some  species  of  animals  are 
naturally  immune  to  certain  infectious  diseases; 
they  even  resist  artificial  infection. 

Natural  immunity  is  due  either  to  the  perfect 
physiological  condition  of  the  body,  with  its 
normal  secretions  and  chemical  reactions,  or  to 
the  resisting  power  of  the  system  developed  by 
evolution. 

Acquired  immunity  is  due  to  the  presence  in 
the  body  of  the  specific  microbe  of  some  disease, 


NATDEAL   SELF-PROTECTION.  177 

in  a  form  sufficiently  benign  to  be  tolerated  yet 
sufficiently  active  to  stimulate  the  formation  of 
the  antitoxins.  In  some  instances  the  germs 
undergo  modification  before  their  entrance  into 
the  body,  and  become  less  active  by  involution 
and  modification  of  their  structure  in  accordance 
with  the  surrounding  circumstances,  as  climate, 
temperature,  etc. 

Artificial  immunity  is  due  to  vaccination, 
antitoxic  serum,  or  accidental  inoculation. 

Immunity  acquired  by  heredity:  Occasionally 
a  person  will  be  found  in  whose  family  a  cer- 
tain common  infectious  disease  has  not  occurred 
for  a  generation,  although  the  members  of 
each  generation  passed  through  one  or  more 
epidemics  of  that  particular  disease  and  took 
no  special  precautions  against  it.  Negroes  en- 
joy an  immunity  from  certain  tropical  diseases. 
Inmiunity  from  the  paternal  side  is  not  as 
readily  transferred  as  from  the  maternal  side. 
Vaccinal  immunity  is  sometimes  transferred 
through  the  placenta.  It  might  be  transferred 
during  the  nursing  period  through  the  milk  of 
the  mother. 

Climatic  immunity:  Persons  who  have  lived 
all  their  lives  in  a  yeUow-fever  region  are  not 
apt  to  contract  yellow  fever,  and  when  they  do 

77037°— 13 12 


178  MEDICAL  HANDBOOK. 

the  disease  usually  manifests  itself  in  a  milder 
form  than  it  would  in  a  newcomer. 

Immunity  acquired  hy  disease:  The  attack  of 
certain  diseases  confers  protection  from  sub- 
sequent attacks  of  the  same  disease,  or  an  attack 
of  a  modification  of  one  disease  confers  im- 
munity from  the  original  source  of  modification, 
as  yellow  fever,  smallpox,  measles,  and  scarlet 
fever. 

Immunity  acquired  hy  accident:  Sometimes 
immunity  to  a  certain  disease  may  be  produced 
by  the  development  of  antitoxins  in  the  body 
through  the  agency  of  food. 

Temporary  immunity  is  due  to  the  develop- 
ment of  an  antitoxin  for  a  short  period,  usually 
a  few  weeks. 

LOSS   OF  RESISTING    POWER    OF   SYSTEM,   AND 
AFFINITIES. 

Temperament  bears  an  indirect  connection 
to  the  resistibility  to  infection.  The  state  of 
the  general  health  appears  to  be  connected  with 
the  susceptibility  to  infection. 

Certain  cells  of  the  body  have  a  minimum  re- 
sistance against  certain  poisons,  which  is  mani- 
fested in  the  case  of  the  tetanus  poison  by  a 
special  affinity  for  the  nervous  system.  Some 
diseases,  as  pneumonia  and  erysipelas,  have  a, 


NATURAL   SELF-PROTECTION.  179 

tendency  to  leave  the  patient  more  susceptible 
to  the  same  disease. 

Immunity  acquired  in  one  country  against 
specific  infectious  diseases  may  be  lost  in  the 
climate  of  another  country. 

From  the  modern  point  of  view,  all  diseases 
are  due  to  exposure  at  a  time  when  the  resisting 
power  of  the  system,  for  some  pathological  rea- 
son, is  suspended.  Disease,  therefore,  may  be 
said  to  be,  with  few  exceptions,  of  accidental 
origin. 

An  individual  may  be  exposed  to  some  infec- 
tious microorganisms,  yet  infection  need  not 
necessarily  follow.  Immunity  depends  not  only 
on  the  body  temperature,  normal  secretions  of 
the  body  glands,  normal  nutrition,  and  normal 
nerve  impulses  but  also,  to  some  extent,  on  the 
mental  condition  of  the  individual  exposed. 
All  of  these  combined  form  a  defense  against 
the  invading  bacteria;  the  bacteria  enter  the 
internal  organs,  but,  meeting  the  natural  resist- 
ing power  of  the  system,  are  destroyed  without 
producing  any  disease.  Unless  this  resistance 
is  lessened,  infection  does  not  occur.  It  is  of 
the  utmost  importance,  therefore,  to  maintain 
the  powers  of  resistance  at  the  highest  possible 
point. 

O 


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